Dental Infection Leading to a Brain Abcess

Case Reports in Emergency Medicine
06 Jan, 2021 ,

Léonor Costa Mendes et.al. presented a case of 7-year-old boy with a brain abscess secondary to a dental infection. He was immediately taken to the operating theatre for drainage and cleaning of the abscess. A dental examination revealed root abscesses on temporary molars, which were extracted under general anaesthetic. Two months after his admission, the child was switched to oral antibiotherapy and could return home. A brain abscess represents a life-threatening disease. Childhood brain abscess is uncommon but may be encountered by all physicians and students as a clinical emergency.

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A previously healthy boy aged 7 years and 11 months was brought to the hospital emergency department suffering from persistent headache and vomiting. He had had a temperature of 38°C for a week and presented a motor deficit of the right arm associated with paresthesiae. A brain CT scan revealed a left fronto-parietal abscess.

Neither his medical history nor the clinical examination provided evidence of ENT (Ear, Nose, and Throat) infection. His mother reported that he had had dental treatment for decay in the left temporal molars three weeks earlier. A brain MRI scan showed a left fronto-parietal lesion of approximately 45 × 52 mm with a right lateral deviation of the median line.

 He was immediately taken to the operating theatre for drainage and cleaning of the abscess. Intraoperative bacteriological specimens were taken, and broad spectrum antibiotherapy was set up using cefotaxime and metronidazole. Corticotherapy (Solumedrol®) was started the following day and continued for six days. Targeted antibiotherapy was set up when the bacteriological analysis results were available.

Direct examination of the bacteriological culture found Gram + cocci in chains, and aerobic and anaerobic culture revealed the presence of Streptococcus intermedius. Two days after surgery, the child was apyretic, with normal heart rate and blood pressure but persistence of a motor deficit of the right arm. A dental examination revealed root abscesses on temporary molars 64 and 65, which were extracted under general anaesthetic thirteen days after the child's arrival at the emergency department. Initial dental treatment was insufficient to manage a potential infection that later became acute.

Twenty-three days after the initial drainage, a control MRI performed because of headaches and vomiting imaged an increase in the volume of the abscess, justifying a second drainage. Bacteriological culture showed the specimen to be sterile. Two months after the first operation, the neurological situation had evolved favourably, the deficit affecting only fine motor skills of the right hand. The brain MRI scan showed a marked decrease in the abscess relative to the previous image.

Two months after his admission, the child was switched to oral antibiotherapy and could return home. Follow-up with control brain MRI was planned at the Children's Hospital at 3 weeks, with a view to stopping the antibiotic treatment.