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Case report
Medullary abscess: a rare clinical presentation
  1. Pavels Muranovs,
  2. Claire Gillon and
  3. John Norris
  1. Neurosurgery, Royal Sussex County Hospital, Brighton, UK
  1. Correspondence to Dr Pavels Muranovs; pavels.muranovs{at}nhs.net

Abstract

Brain abscesses represent areas of localised infection of the brain parenchyma. Those confined to the brainstem are rare and usually fatal if untreated. Streptococcus intermedius is a common causative organism of brain abscesses and is associated with significant morbidity. We describe a case report of medullary abscess secondary to dental infection in a 68-year-old patient. The patient presented with headaches and flu-like symptoms progressing to left hemiparesis and reduced consciousness/bulbar function. The patient underwent emergency posterior fossa craniectomy and drainage with subsequent medical management with antibiotics. Prompt diagnosis, early surgical intervention and maximal therapy with antibiotics alongside extensive rehabilitation are all vital to ensure good neurological outcome. It is imperative for medical practitioners to consider the diagnosis of brain abscess in patients presenting with rapid onset neurological deterioration. Such cases require early neurological imaging with involvement of tertiary neurosurgery services.

  • brain stem / cerebellum
  • infection (neurology)
  • cranial nerves
  • neuroimaging
  • adult intensive care
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Footnotes

  • Contributors PM and CG wrote and designed the primary manuscript. JN reviewed the primary manuscript. PM, CG and JN were all responsible for revising the manuscript to the final version and take responsibility for content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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