Bilateral SDH with Sepsis Due to Citobacter Koseri Mimicking Stroke

Central Nervous System (CNS) infections are severe post operative complication of craniotomy, especially in elderly patients that are already immunologically compromised resulting in prolonged management of primary pathology due to active infection and poorer treatment outcomes. The interplay between the primary pathology and the development of a severe infection makes management challenging.. Abrupt onset of unilateral weakness and speech disturbance is important feature of stroke but there are several non vascular conditions which mimic stroke. Severe sepsis is one of these conditions and can lead to cerebral dysregulation, which in turn causes brain hypoperfusion and a stroke-like picture. This is a critical reminder that a comprehensive evaluation, including infection workup, is essential when new neurological deficits appear in post-operative patients. We report one such operated case of bilateral SDH with sepsis due to Citrobacter koseri presenting with stroke like symptoms. In this case, the organism caused severe invasive infection, likely contributing to sepsis, brain hypoperfusion, and potentially exacerbating the patient's neurological status. The recognition of such infections is crucial because their presentation may mimic more common post-operative complications like stroke, leading to potential misdiagnosis and delays in appropriate treatment. The emergence of Citrobacter koseri as a cause of severe invasive infection in neurosurgical patients underscores the need for heightened awareness of both unusual pathogens and atypical presentations. This also highlights the importance of early detection, appropriate antibiotic therapy, and multi-disciplinary management in reducing morbidity and mortality associated with these infections.