Brain Abscess as a Cause of Macrocephaly in a Newborn
Pediatric Neurology
A 5-month-old boy with no remarkable prior medical problems was referred for evaluation of macrocephaly. The growth in head circumference, developed over several weeks, was apparently asymptomatic, but even basic recall and history-taking was hampered by idiomatic and social barriers with the patient's family. Examination revealed a febrile patient (38.1°C) with a head circumference of 45 cm, tense fontanelle, and downward gaze. The rest of his examination was normal, including pupil size and reactivity, limb mobilization, and alimentation. Blood and urine analysis was relevant only for leukocytosis (26.4 × 103/mm3 [7.5-13.5]) and a C-reactive protein of 62.2 mg/L (<15). Blood and urine cultures were negative. No local, distant, or procedural infection, present or recent, was identified. Magnetic resonance imaging of the brain revealed a lesion in the right hemisphere with severe mass effect on all intracranial structures ( A). An urgent burr-hole craniostomy allowed catheterization of an abscess and drainage of 100 mL of pus. Antibiotics were injected and drained. Intravenous antibiotics were started. Microbiology of the abscess was positive for Staphylococcus aureus. Despite a favorable clinical course, a repeated surgical drainage was necessary to obtain radiologic resolution of the abscess ( B).
Original Article: http://www.pedneur.com/article/S0887-8994(13)00557-2/abstract?rss=yes
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