This patient's initial presentation was not suggestive of neurological pathology. Testicular pathology was excluded by ultrasound.

The subsequent sudden-onset mild subjective right-sided weakness and paresthesia prompted a non-contrast CT. This was unremarkable.

Ongoing deterioration caused a right-sided neuromotor deficit with 0/5 power. GCS was still 15. This lead to a MRI that demonstrated findings consistent with lobar hemorrhages. In the setting of systemic symptoms and  Staphylococcus aureus positive blood cultures the possibility of superimposed infection or hemorrhagic cerebritis where considered. 

With further deterioration in GCS, urgent neurosurgical intervention with drainage of the cerebral collection was performed. A small amount of blood-stained was fluid aspirated.

The pathology report from the left frontal lesion noted interstitial hemorrhage and acute inflammation with scant Staphylococcus aureus growth. The fluid sample also grew a scant amount of the same species.

A swab from a wound found on the left lateral malleolus grew Staphyloccus aureus. This was thought to be the source of infection.

The final contrast CT demonstrates anatomic correlation to eventual significant neurological deterioration.   

It remains unclear what precipitated these lobar hemorrhages and how they relate to sepsis. Possibilities include:

1. CT-occult cerebritis that progressed to hemorrhage
2. cerebral vein thrombosis (not visualized)
3. mycotic aneurysms from sepsis