The aim of this article was to present a rare and potentially life-threatening complication of malignant cerebral infarct turning into a massive cerebral abscess. Cerebral abscess complicating cerebral infarction is rare. Only 13 cases have been reported. Unexplained fever is the presenting symptom. The case presented here is unique, as the patient was totally asymptomatic and the abscess was detected incidentally during surgery. A 42-year-old man with malignant left anterior cerebral artery and middle cerebral artery territory infarct underwent decompressive craniotomy 5 weeks before presenting to the authors’ institution. The patient had features of sunken skin flap syndrome. Therefore, cranioplasty was planned. During surgery, false dura was inadvertently opened due to adherence with pia and pus started coming out. On exploration, approximately 150 mL of pus was evacuated. The whole infarcted brain was seen to be converted into a cavity full of pus. Adequate drainage and debridement were done. Cranioplasty was deferred. The patient was treated with broad-spectrum antibiotics postoperatively, and he recovered well. Cerebrovascular accident (CVA) is one among the common causes for mortality and morbidity worldwide. The infarcted or ischemic brain acts like a fertile ground for the pathogens to grow. Disruption of blood–brain barrier and lack of normal blood flow by the vascular event facilitate microbial seeding and formation of cerebral abscess. Abscess formation following stroke is rare. It could prove to be fatal if misdiagnosed or not properly treated. Uncontrolled fever in a stroke patient should raise the suspicion of this rare complication. A routine contrast computed tomography of the brain prior to cranioplasty may pick up this complication in asymptomatic patients. Conservative treatment alone proves fatal in almost all cases.

Spinal tuberculosis (TB) is well studied and described in the literature. It is known to occur anywhere along the transverse plane of the spine. Vertebral TB accounts for less than 1% of all TB infections in the body and more than 50% of musculoskeletal infections. It is considered the most serious type of skeletal TB, with possible neurological symptoms due to compression of neural structures. It may also lead to deformity and significant vertebral structure destruction and instability. Though non-osseous intraspinal extradural tuberculous granulation tissue is reported in several instances, to the best of our knowledge and thorough literature search, the post-laminectomy occurrence of extradural tuberculous granuloma is not reported in the literature so far. Whether it is the reactivation of previously dormant tuberculous infection or naive infection is elusive. Surgical excision and anti-tuberculous therapy is the mainstay of treatment.

Schwannomas are one of the most common primary spinal tumors representing 30% of all intraspinal lesions. Intramedullary schwannomas constitutes 0.3% of all intraspinal tumors and approximately 1% of spinal cord schwannomas. Majority of the tumors are seen in the cervical (58%), followed by thoracic (32%) and lumbar (10%) regions. Very few are reported at the level of conus medullaris. The important radiologic features of intramedullary schwannoma are predominant extramedullary component, intramedullary spinal tumor with a thickened and enhancing spinal nerve root, absent syrinx, enhancing well with contrast, and sharp margins. The aim of surgery in intramedullary spinal schwannomas is total removal whenever possible. Diagnosing intramedullary schwannoma preoperatively needs high index of suspicion. We are reporting the 10th case of intramedullary schwannoma in the conus region.