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Non-surgical treatment of the solitary brain abscess in children
Insights
A solitary brain abscess in a child with congenital heart defect resolved with a four-week antibiotic regimen. Follow-up showed complete neurological recovery and normal imaging.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Cardiology
Background:
- Congenital heart defects, such as pulmonary stenosis, can increase infection risk.
- Dental procedures can be a source of bacteremia, potentially leading to brain abscesses.
Observation:
- A 10-year-old girl with operated pulmonary stenosis developed a right frontotemporal brain abscess post-dental extraction.
- Clinical presentation included fever, headache, and left-sided grand mal seizures.
- Electroencephalography (EEG) and computed tomography (CT) scans confirmed the brain abscess.
Findings:
- The brain abscess was treated with a 4-week intravenous antibiotic course including penicillin, chloramphenicol, and cloxacillin.
- Significant clinical improvement, alongside normalized EEG and CT findings, was observed within two weeks of treatment.
- Complete resolution of the abscess cavity and normal neurological status were achieved three months post-therapy.
Implications:
- Prompt antibiotic treatment can effectively manage brain abscesses in pediatric patients with congenital heart defects.
- This case highlights the importance of considering infectious complications after dental procedures in immunocompromised children.
- Successful treatment leads to complete neurological recovery and normal long-term development.
Abstract:
In a ten year old girl with operated congenital heart defect: pulmonary stenosis, a solitary brain abscess developed in the right frontotemporal region after teeth extraction. The clinical disease was manifested with fever, headache and by tonic epileptic seizure of the grand mal type dominating on the left side. Suspicion of the abscess existence has been raised on the basis of the EEG finding and proved by the brain CT scan. Agent has not been identified, most probably due to antibiotic therapy applied prior to admission. We decided for the antibiotic treatment with benzilpencillin (500,000/kg/day), chloramphenicol (50 mg/kg/day) cloxacillin (130 mg/kg/day) intravenously during 4 weeks. Clinical improvement of the condition, the EEG and CT findings occurred two weeks after the beginning of the therapy. After a month further marked improvement of the EEG findings occurred as well as the disappearance of the abscess cavity. Three months after the completed therapy the control EEG and the brain CT scan were normal. The girl having been followed up for three years is growing normal and has completely normal neurologic findings.