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Epidural abscess presented with psychiatric symptoms

C Z Chang¹, C J Wang, S L Howng

¹Department of Surgery, Kaohsiung Medical College, Taiwan, Republic of China.

The Kaohsiung Journal of Medical Sciences

|February 12, 1998

Summary

A rare cranial epidural abscess caused psychiatric symptoms, including hallucinations, in a patient. Surgical removal of the abscess resolved these symptoms, highlighting a link between brain abscesses and psychiatric disturbances.

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Area of Science:

Neurosurgery
Neurology
Psychiatry

Background:

Cranial epidural abscesses are uncommon neurosurgical conditions, often arising from osteomyelitis or infections.
These abscesses pose significant risks, including high mortality and morbidity due to potential complications like thrombophlebitis and venous sinus involvement.

Observation:

A patient presented with persistent psychiatric symptoms, including bizarre behavior and hallucinations, for two years.
Incidental brain imaging revealed a large epidural abscess compressing critical limbic system structures.

Findings:

Surgical intervention and removal of the epidural abscess led to the complete resolution of the patient's psychiatric symptoms.
The abscess had compressed the amygdala, entorhinal cortex, cingulate gyrus, hippocampus, and parahippocampal gyrus, all part of the limbic system.

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Implications:

This case underscores the potential for structural brain lesions, like epidural abscesses, to manifest as psychiatric disorders.
Effective management requires multidisciplinary collaboration between psychiatrists, neurologists, and neurosurgeons for accurate diagnosis and treatment.