she was referred to saitama hospital due to severe headache and nausea on october 2008 . brain mri detected a 1.5 cm abscess mass with extensive edema in the right frontal lobe . we performed intensive therapy using some antibiotics that included cefotaxime and meropenem and depressants for intracranial pressure for six weeks . there was a good prognosis for the woman and her fetus without any sign of neurological abnormalities . early medical intervention is required before it is too late for brain abscess in pregnancy . brain abscess caused by bacterial infection has extremely low incidence , and a high mortality rate of 30% . it causes poor prognosis for both mother and fetus , regardless of the state of pregnancy . unlike non - pregnant women a 24-year - old woman who lived in saitama , japan had three pregnancies , two childbirths , body mass index ( bmi ) of 22.3 , and unremarkable past medical and family histories . she also had an uneventful first trimester , but developed a fever of > 39c at 22nd week , 1st day of pregnancy . because of prolonged headache and nausea , she was referred to our hospital in saitama for complete physical examination on october 2008 . on admission , she had blood pressure of 103/51 mmhg , heart rate of 100 beats per min ( bpm ) , body temperature of 39.0c , mild stiffness in the neck , and cold extremities . however , brain computed tomography ( ct ) for the prolonged headache revealed a 1.5 cm mass in the right frontal lobe , while hematological analysis showed an elevated white blood cell count of 12,400 cells/l ( neutrophils , 87.7% ) . cerebrospinal fluid findings were positive for gram - positive bacteria , an increased cell count ( especially for neutrophils ) of 2,332 cells/l , and a low glucose concentration of 30 mg / dl . brain mri revealed a 1.5 cm mass with a high intensity signal inside and a low intensity t2 signal on the margin in the deep white matter of the right frontal lobe . based on the above findings and a high intensity zone surrounding the mass on diffusion - weighted images , she was immediately placed on intensive therapy with concurrent administration of antibiotics cefotaxime ( 2 g / day ) and meropenem ( 3 g / day ) , as well as glycerin 20 g / day to reduce intracranial pressure . table 1 shows a list of examinations performed in search of causal factors , while the results show the isolation of methicillin - sensitive staphylococcus aureus ( mssa ) from the throat . on the other hand , she had no dental problems . because of unremarkable upper gastrointestinal endoscopy findings and a negative fecal occult blood test result , the possibility of brain metastasis of a malignant tumor was ruled out . after six weeks of intensive therapy with concurrent administration of two antibiotics and glycerin , the headache and nausea disappeared along with a reduction in the number of white blood cells . subsequent brain mri at 28th week , 4th day of pregnancy showed no enlargement of the abscess and disappearance of the surrounding edema , with no indication of puncture drainage . at this point , she was switched to oral administration of amoxicillin 750 mg / day for four weeks and was discharged at 29th week , 3rd day of pregnancy . body temperature slowed down after the day 7 causes of brain abscess mssa : methicillin - sensitive staphylococcus aureus , cns : coaglese negative staphylococcus she vaginally delivered a 2,890 g girl baby at 38th week , 5th day of pregnancy , with no abnormalities . no neurological abnormalities were evident during a five - year follow - up observation conducted over the phone . mri findings at the 22nd and 28th week of pregnancy are shown in figure 2 . a : axial image at 22ne week of pregnancy shows the large right frontal abscess with severe edema . b : axial image at 28th week of pregnancy shows no enlargement of the abscess and disappearance of the surrounding edema despite the extremely low incidence , brain abscess caused by bacterial infection has a high mortality rate of 30% and is therefore a disease with poor prognosis for both mother and fetus , regardless of the state of pregnancy . although we listed previous reports on brain abscess during pregnancy ( table 2 ) , it should be noted that the number is extremely small ( 16 ) . approximately , 7% of the previous cases were related to dental treatment ( 7 ) , but no dental abnormalities were observed in the present case . during the pregnancy , maternal immunity is reduced due to a hormonal imbalance , and according to lanciers et al . , 26.6% of pregnant women , as opposed to 11.0% of non - pregnant women , are significantly infected with helicobacter pylori ( 8) . it goes without saying that organisms with low pathogenicity under normal circumstances can cause serious infection during pregnancy . in this case , the clear source of infection was not identified . it seems that the pregnant woman whose immunity was diminished is vulnerable to mssa , which was extremely rare and considered as a serious case . brain abacess in pregnancy ( literature review ) the symptoms of brain abscess include headache , nausea , and localized neurological abnormalities ( 9 ) . headache is the most common symptom , occurring in 75% of pregnant women , followed by 67% of neurological abnormalities and 58% of altered consciousness ( 10 ) . although no adverse effects of mri have been reported ( 11 , 12 ) , the ct should be avoided as much as possible because there are some problems about the degree of radiation exposure in pregnant women . therefore , mri may be a safer and is a highly sensitive diagnostic imaging modality for use in pregnancy ( 13 ) . yet , because of potential thermal tissue damage due to the high magnetic field , the national radiological protection board recommends that pregnant women avoid mri examination during the first trimester . to treat a brain abscess , it is necessary to select antibiotics capable of effectively crossing the blood brain barrier and their sensitivity should be proven in bacterial culture . the use of steroidal drug is also recommended to prevent an increase in intracranial pressure and the development of brain edema ( 13 ) . however , because intensive therapy for a brain abscess with antibiotics and steroidal drugs takes somewhere between six to eight weeks , its effect on the fetus is a huge concern . betamethasone and dexamethasone , which are transported via the placenta , should be avoided because they may affect the development of the fetal central nervous system . furthermore , the early administration of antiepileptic drugs is recommended because 70% of patients with a brain abscess develop epilepsy ( 13 ) . even infection by vulnerable bacteria becomes serious and early treatment intervention is desirable because immunity power diminishes during the pregnancy . our treatment obtained ethics approval from the regional ethics committee responsible for human experimentation and conformed to the provisions of the declaration of helsinki .
introductionbrain abscess in pregnancy is very rare , which mostly progresses to neurological abnormalities.case presentationthe patient is a 24-year - old pregnant woman . 
 she was referred to saitama hospital due to severe headache and nausea on october 2008 . 
 brain mri detected a 1.5 cm abscess mass with extensive edema in the right frontal lobe . 
 we performed intensive therapy using some antibiotics that included cefotaxime and meropenem and depressants for intracranial pressure for six weeks . 
 there was a good prognosis for the woman and her fetus without any sign of neurological abnormalities.conclusionearly medical intervention is required before it is too late for brain abscess in pregnancy .