Neuropsychiatric Disease and Treatment Open Access Full Text Article Effect of rehabilitation on a patient suffering from a tuberculous brain abscess with Gerstmann’s syndrome: case report Dovepress open access to scientific and medical research C A S E R E P O R T Chih-Lan Kuo1 Sui-Foon Lo1,2 Chun-Lin Liu3 Chia-Hui Chou4 Li-Wei Chou1,2,5 ¹Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; ²School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 3Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan; 4Department of Infectious disease, China Medical University Hospital, Taichung, Taiwan; 5Department of Physical Therapy, China Medical University, Taichung, Taiwan Correspondence: Li-Wei Chou Department of Physical Medicine and Rehabilitation, China Medical University Hospital, No 2 Yuh-Der Road, Taichung 404,Taiwan Tel +88 64 2205 2121 ext 2381 Fax +88 64 2202 6041 Email chouliwe@tcts.seed.net.tw submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/NDT.S31713 Abstract: There are few reports in the literature of tuberculous brain abscess. Tuberculous brain abscess usually occurs in an immunocompromised host. Almost all previously documented cases have involved acquired immune deficiency syndrome. We encountered a 53-year-old right-handed immunocompetent male who was initially suspected of having a cerebrovascular accident due to acute-onset right hemiparesis and paresthesia. A tentative diagnosis of brain tumor versus brain abscess was made on imaging studies. The patient was finally diagnosed with a tuberculous brain abscess based upon deterioration on imaging and a positive tuberculosis culture. The tuberculous brain abscess was located in the left parietal lobe, which resulted in Gerstmann’s syndrome and right-sided apraxia. Stereotactic surgery was performed. He was also given antituberculosis chemotherapy and comprehensive rehabilitation. Considerable improvement was noted after rehabilitation. The patient even returned to a normal life and work. Our case demonstrates that an aggressive intensive inpatient rehabilitation program combined with stereotactic surgery and effective antituberculosis therapy play an important role in improving the outcome for patients with tuberculous brain abscess, Gerstmann’s syndrome, and right-sided apraxia. Keywords: tuberculous brain abscess, Gerstmann’s syndrome, rehabilitation Introduction Tuberculosis (TB) most commonly affects the lungs,1 with extrapulmonary TB observed in only 20% of all cases.2 TB of the central nervous system accounts for approximately 1% of all TB cases.3 Most cases of TB affecting the central nervous system develop in immunocompromised persons with pulmonary TB,4,5 and com- monly manifests as meningitis or tuberculoma.6,7 Tuberculous brain abscess is a very uncommon form of TB in the central nervous system.6,7 Diagnosis of a tuberculous brain abscess may be very difficult in a person without a history of contact with TB or without pulmonary TB. Symptoms of tuberculous brain abscess also depend on the location of the lesion. A tuberculous brain abscess may mimic a cerebrovascular accident or a brain tumor. Lesions located in the left parietal lobe may result in Gerstmann’s syndrome. Here we present a case present- ing as Gerstmann’s syndrome secondary to a rare tuberculous brain abscess without primary pulmonary lesions or immunocompromise. Case report A 53-year-old right-handed man complained of acute-onset right-sided weakness and paresthesia. He was reportedly healthy with no chronic or infectious diseases. Neuropsychiatric Disease and Treatment 2012:8 217–220 © 2012 Kuo et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 217