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Medullary abscess: a rare clinical presentation

Pavels Muranovs1, Claire Gillon2, John Norris2

  • 1Neurosurgery, Royal Sussex County Hospital, Brighton, UK pavels.muranovs@nhs.net.

BMJ Case Reports
|March 13, 2020
PubMed

Insights

Brainstem abscesses, often fatal if untreated, are rare infections. Prompt diagnosis and surgical intervention for brain abscesses, like this medullary case from dental infection, are crucial for patient survival and recovery.

Area of Science:

  • Neurology
  • Neurosurgery
  • Infectious Diseases

Background:

  • Brain abscesses are localized brain infections, with brainstem abscesses being rare and typically fatal if untreated.
  • Streptococcus intermedius is a frequent cause of brain abscesses, leading to significant patient morbidity.

Observation:

  • A case report details a 68-year-old patient with a medullary abscess secondary to a dental infection.
  • The patient exhibited symptoms including headaches, flu-like illness, left hemiparesis, and declining consciousness and bulbar function.

Findings:

  • Emergency posterior fossa craniectomy and abscess drainage were performed, followed by antibiotic treatment.
  • The case highlights the importance of prompt diagnosis and early surgical intervention in managing brain abscesses.

Implications:

  • Effective management requires a combination of early surgical intervention, maximal antibiotic therapy, and comprehensive rehabilitation for optimal neurological outcomes.
  • Medical practitioners must consider brain abscesses in patients with rapidly worsening neurological deficits, necessitating urgent neuroimaging and neurosurgical consultation.
Keywords:
adult intensive carebrain stem / cerebellumcranial nervesinfection (neurology)neuroimaging

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