{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:16:51Z","timestamp":1793121411750,"version":"4.5.0"},"reference-count":30,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Brain abscess formation at the site of intracerebral hemorrhage (ICH) is extremely rare, particularly in association with anaerobic pathogens, such as\n                      <jats:italic>Bacteroides fragilis<\/jats:italic>\n                      , and its pathogenesis remains incompletely understood. Here, we report an ultimately fatal case of a brain abscess caused by this organism that developed at an ICH site.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Case Description:<\/jats:title>\n                    <jats:p>\n                      An 86-year-old woman presented with right parieto-occipital ICH accompanied by systemic inflammatory signs. Abdominal computed tomography performed at admission revealed findings consistent with sigmoid diverticulitis. Despite initial conservative management, the patient developed bacterial meningitis due to\n                      <jats:italic>B. fragilis<\/jats:italic>\n                      . Sixteen days after stroke onset, she experienced rapid neurological deterioration caused by massive perilesional edema. Emergency surgery revealed purulent material within the hematoma cavity, and cultures confirmed\n                      <jats:italic>B. fragilis<\/jats:italic>\n                      , establishing a diagnosis of secondary abscess formation at the ICH site. Although surgical intervention and targeted antimicrobial therapy were initiated, the patient developed cerebritis and ventriculitis and ultimately died.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case suggests that hematogenous dissemination from an intra-abdominal infection may seed injured brain tissue in the early phase after hemorrhage. Disruption of the blood\u2013brain barrier and the relatively avascular, anaerobic environment of a hematoma may predispose patients to abscess formation. In patients with ICH, persistent fever and progressive neurological deterioration despite antimicrobial therapy should prompt consideration of contrast-enhanced neuroimaging to evaluate possible intracranial infectious complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.25259\/sni_547_2026","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T09:42:19Z","timestamp":1784886139000},"page":"420","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Early secondary brain abscess formation caused by\n                    <i>Bacteroides fragilis<\/i>\n                    at the intracerebral hemorrhage site: A case 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