Pregnancy-related cerebral abscess

BACKGROUND- Cerebral abscess during pregnancy and the puerperium is distinctly rare. REVIEW SUMMARY- We report two new cases, one a postpartum, nonimmunocompromised, previously healthy patient and the other a 23-week pregnant patient with mild systemic lupus erythematosus, both of whom developed cerebral abscesses. To clarify the clinical and prognostic features of this previously anecdotal entity, we reviewed the available world literature and found 11 other pregnancy-associated cerebral abscesses. Approximately half of the cases were associated with noneclamptic deliveries, and these had a lower mortality (20%) compared with eclampsia-associated cerebral abscess (mortality 50%). Clinical features were not always focal and included headache and altered sensorium, including coma and death. The majority of the abscesses were single and supratentorial. The signs and symptoms of puerperal cerebral abscess are not specific and therefore may overlap with eclampsia, making the differentiation of these two entities difficult at times. CONCLUSION- Although very rare, brain abscess should be considered in the differential diagnosis of central nervous system complications of pregnancy and the postpartum period.