We report a case of chronic encapsulated intracerebral hematoma that was difficult to differentiate from brain abscess. The patient was a 51-year-old man with a history of Marfan syndrome associated with periprosthetic infection after surgery. When he woke up at 8:00 in the morning, he became aware of right hemiparesis, speech disturbance and right homonymous hemianopia. A brain CT revealed a left occipital subcortical hemorrhage. He was admitted to our hospital. His hematoma had no recurrence, but a CT scan after 23 days of hospitalization showed an enlarged edema around the hemorrhage with a ring-shaped enhancement. A brain abscess was strongly suspected based on the course of fever and blood culture. We performed craniotomy after 27 days of hospitalization. However, no abscess was observed within the capsule, the organized hematoma surrounded by a capsule was removed. It has been reported that chronic encapsulated intracerebral hematoma presents similar imaging findings to metastatic brain tumor, glioblastoma and brain abscess, and that the clinical course is also similar. As reported cases are rare, further investigation including the pathology and risk factors are necessary.
