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We report a clinical case of Filifactor alocis brain abscess in an 85-year-old man who had decayed teeth 1 week prior. In this case, the abscess was surgically drained after empirical antibiotics had been initiated. Although the causative organism could not be identified by culture, F. alocis was detected via 16S ribosomal RNA (16S rRNA) gene sequencing of the pus isolated from the abscess. The patient recovered without serious sequelae after surgical drainage and prolonged antibiotic treatment, including metronidazole, ceftriaxone and meropenem for 8 weeks. The findings in this case emphasize that 16S rRNA gene sequencing allows bacterial diagnosis of brain abscess when phenotypic identification fails, such as in cases where patients are undergoing antimicrobial treatment at the time of sampling or where patients are infected with fastidious organisms.

For patients with acute myelogenous leukemia (AML) and invasive central nervous system lesions, there are many possible differential diagnoses, including collagen diseases, infectious diseases, drug reactions or side effects, and vascular diseases. Herein, we describe the clinical course, diagnostic examinations, and treatment outcomes for a patient with AML complicated by a progressively enlarging intracranial necrotic lesion. As no tumor cells were seen on microscopic examination, and since the clinical symptoms improved after leukemia therapy, myeloid sarcoma was highly suspected. Taken together, this case suggests that a combination of the clinical course, radiological findings, and treatment history should be considered to eliminate other possible diagnoses.

Cavernous Sinus Cavernous Hemangioma (CSCH) is a relatively rare vascular lesion, accounting for 0.4-2.0% of tumors of the cavernous sinus. Due to multiple differential diagnoses, a diagnosis based on pre-operative imaging is very important. This case report describes a patient with CSCH in whom it was difficult to determine a pre-operative diagnosis based on imaging modalities.

Background: The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time dependent, and national guidelines recommend door-to-needle (DTN) time within 60 minutes. Several strategies have been reported to be associated with reducing DTN times. However, effectiveness of such strategies has not been fully evaluated. Methods: In 2014, we assembled a multidisciplinary team called ‘Acute Stroke Team (AST)’ aiming for improving outcomes of patients with acute ischemic stroke, especially by reducing onset-to-treatment time. A new protocol was implemented to minimize delays: AST staff prenotification, parallel process workflow, and rapid acquisition of laboratory testing and brain imaging. AST reviewed all intravenous tPA cases and discussed the points of improvement. AST also organized both public and in-hospital lectures, and simulation training course. We compared patients received intravenous tPA within 4.5 hours from the symptom onset at our institute in the pre AST (April 2011 - August 2014) and post AST (September 2014 - July 2016) period. Using univariate methods and multivariable logistic regression, we assessed the associated factors with favorable outcomes. Results: In the pre and post AST period, 46 and 36 patients were treated with intravenous tPA, respectively. Compared with pre AST period, the median (interquartile range) DTN times was reduced from 71 (63-95) minutes to 55 (49-71) minutes (p Conclusions: Multidisciplinary team-based approach reduced DTN times. Reducing DTN times was associated with improving patient outcomes. Future efforts should focus on sustainability and safety of this approach.