Cerebral Abscess Presenting as a Complex Febrile Seizure

Area of Science:

• Pediatric Neurology
• Neuroimaging in Children
• Infectious Diseases

Background:

• Management of complex febrile seizures lacks standardized guidelines, particularly regarding neuroimaging.
• No established practice guidelines exist for neuroimaging in pediatric febrile seizures.

Observation:

• A 2-year-old female presented with a complex febrile seizure, initially appearing well with a normal neurological exam.
• The patient returned the next day with altered mental status, toxic appearance, and focal neurological deficit (right lower extremity weakness).
• Brain MRI revealed a left-sided cranial empyema, requiring antibiotics and surgical drainage.

Findings:

• Literature review suggests neuroimaging is not routinely indicated for well-appearing children with complex febrile seizures and no focal neurological deficits.
• This case highlights that serious intracranial pathology, such as empyema, can present in the context of complex febrile seizures.
• The utility of CT, MRI, and lumbar puncture in febrile seizure work-up is supported by limited retrospective data.

Implications:

• While generally not required, emergent neuroimaging and/or lumbar puncture may be necessary in complex febrile seizure cases with concerning clinical signs.
• Physicians must maintain a high index of suspicion for rare but severe conditions like meningitis and brain abscess.
• This case underscores the importance of vigilant follow-up and reassessment in pediatric febrile seizure management.