1Royal London Hospital, Barts Health NHS Trust, Ear, Nose & Throat department, London, United Kingdom
Introduction. Brain abscesses are uncommon, serious, and life-threatening conditions with high morbidity. Signs and symptoms of brain abscesses are variable and non-specific. Common symptoms are headaches, fever, focal neurological symptoms, altered mental state, nausea and vomiting. Seizures are less common. A high clinical suspicion is necessary to confirm the diagnosis. A Computer Tomography (CT) scan of the brain with contrast is a gold standard to diagnose brain abscesses.
Clinical case. A 23-year-old gentleman was found on the floor at home with tonic-clonic seizures. He had a 3-weeks history of headaches, purulent smelly discharge from his nose, symptoms of photophobia, and recent covid infection. The patient was not on any treatment – he was due to see his general practitioner for his symptoms. On the patient’s arrival, the emergency team requested a CT of the head which showed 4.5 x 2.3 x 2.4 cm thick-walled gas and fluid containing collection within the left frontal lobe coming from breaches left frontal sinus. The patient had endoscopic sinus surgery and bifrontal decompressive craniectomy followed by admission to the intensive care unit. A brain stem test was done which showed devastating brain injury. The patient died on day 7.
Conclusion. Although there are no acceptable management guidelines, the three most important steps in managing brain abscesses caused by sinusitis are broad-spectrum antibiotics, endoscopic sinus surgery, and decompression and drainage of the abscess. Conservative management can be considered for abscesses smaller than 2.5 cm.
Keywords. Brain,abscess, sinusitis.