Central Nervous System Infections

Case 2:

Ms. Umbridge, a professor at Harry’s prestigious school, is a 53-year-old woman who presents to your clinic with headaches and trismus for the past 2 weeks. She was receiving treatment at a dental clinic for the past two weeks without relief, and now comes to you for assistance. On exam, she has right-sided facial swelling of her upper cheek and has difficulty opening her mouth (which you don’t mind, given her predilection for manipulation). MRI of the brain reveals a 1.8 x 1.3 cm R temporal brain abscess. Which of the following is true?

a.       Brain abscess from an odontogenic (dental) source is uncommon.

b.       Brain abscesses tend to be monomicrobial.

c.       Antibiotic treatment duration for brain abscess is typically 4-8 weeks.

d.       Lumbar puncture should be performed in all cases of brain abscess.

Explanation:

A brain abscess is a focal infection of brain parenchyma that can arise from hematogenous seeding or due to direct spread from a contiguous anatomical region. We’ll discuss this in some more detail in the module but suffice it to say, brain abscesses commonly occur due to local spread from sinusitis, otitis media or mastoiditis, or odontogenic infection. They also tend to polymicrobial as a result. The answer here is C.

Lumbar puncture is contraindicated in cases of brain abscess because of the potential for increased intracranial pressure and risk of herniation.