Neglected massive intracerebral abscess: an unusual cause of bilateral visual loss

Bilateral visual loss following chronically raised intracranial pressure is not uncommon especially in developing countries. However, this calls for concern when the cause of the raised intracranial pressure is neglected pyogenic cerebral abscess.

A sixteen year old male student presented to our unit with eight months history of recurrent headache associated with early morning vomiting. He developed bilateral visual loss a month prior to presentation. He had sought treatment at several herbal homes and orthodox hospitals before presentation. His cranial computed tomographic scan (CT) showed a massive peripheral contrast enhancing lesion in the frontal lobes with gross midline shift and other evidence of mass effect. He subsequently had craniotomy and excision of the mass. Intraoperative and laboratory findings confirmed the lesions to be abscess. He had ciprofloxacin and metronidazole for four weeks. He had uneventful postoperative period though his visual loss has persisted. He is being followed up in the clinic.

This patient illustrates that untreated frontal lobe abscess could cause bilateral visual loss from chronically elevated intracranial pressure (ICP). Even though this should be rare in contemporary neurosurgical practice, ignorance and poverty which are rife in developing countries will be important contributory factors. Physicians working in developing countries should be aware of the symptomatology of cerebral abscess and raised ICP. They should encourage patients to do cranial CT when the features are suggestive of space occupying lesions.