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Pasteurella multocida is a common cause of infection following bites or scratches caused by cats and dogs. It is a rarely reported and often overlooked pathogen. Typical presentation is a rapidly developing cellulitis at the infection site. Here we present a rare case of worsening lower extremity paraplegia due to a spinal epidural abscess caused by P. multocida. The patient was a 56-year-old female who had been experiencing several days of back pain, became septic and went on to develop paraplegia. Failure to improve prompted re-evaluation of the diagnosis with subsequent imaging notable for a spinal epidural abscess. Blood cultures grew P. multocida but were initially misidentified as Haemophilus influenzae and only with targeted antibiotic therapy and neurosurgical intervention did she begin to improve. Obtaining an animal history and knowing when to re-evaluate a diagnosis are essential skills for any clinician.

Acute otomastoiditis is a potentially life-threatening condition. It is relatively uncommon in elderly patients and is usually seen as a complication of acute otitis media. Limited studies are available on this uncommon disease in the elderly, and thus the clinical course of the disease is not fully understood. Proper use of antibiotics for acute otitis media has markedly decreased the incidence of acute otomastoiditis. We describe a case of a 76-year-old male with acute otomastoiditis complicated by cerebellopontine angle epidural abscess who presented with a chief complaint of sudden onset of global aphasia, which is an unusual presentation for acute otomastoiditis. The patient eventually required medical and surgical intervention. To the best of our knowledge, acute otomastoiditis presenting with sudden onset of global aphasia has not been previously described in the literature. This case illustrates how multidisciplinary team involvement is vital in the management of these uncommon cases.

Pott’s puffy tumor, typified by a subperiosteal abscess underlying the frontal bone, is an uncommonly encountered clinical entity that can occur in the setting of local trauma or secondary to frontal sinusitis. Diagnosis can be challenging, as cultures may be sterile, and the condition must be differentiated from neoplasm and superficial and soft tissue infection. Although more common in the pediatric population, Pott’s puffy tumor must remain on the differential with a high index of suspicion in adult patients who fit the clinical picture. Early diagnosis with CT or MRI and therapeutic medical and surgical intervention are crucial as intracranial complications, such as abscess and empyema can occur and may be fatal. We present an adult patient with a history of inhaled drug abuse who presented with Pott’s puffy tumor with meningitis and bifrontal epidural abscesses at presentation. There is evidence in the literature that management of sinus-related intracranial epidural abscess with antibiotic therapy and adequate surgical or endoscopic surgical drainage may bypass the need for neurosurgical intervention, as was the case here.

Intracranial extension of rhinosinusitis is rare in children. We report a 9-year-old immunocompetent boy with central precocious puberty and obstructive sleep apnea-hypopnea syndrome who developed an intracranial epidural abscess secondary to rhinosinusitis while on continuous positive airway pressure (CPAP) treatment. A retrospective review of the medical record and imaging studies was performed. MEDLINE and Cochrane databases were searched for reports of epidural abscess developing in patients receiving CPAP treatment or in patients with precocious puberty. Intracranial extension of frontal rhinosinusitis is more common during puberty probably because of the active growth of the frontal sinuses and their rich blood supply. Controlled studies show no increase with rhinosinusitis in adults on CPAP; no published studies assess intracranial extension of rhinosinusitis in CPAP use. Patients with unexplained, severe headache and fever following CPAP use may require neuroimaging (magnetic resonance imaging [MRI] / contrast computed tomography) to rule out intracranial extension of sinusitis.

The authors describe a case of infratentorial epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a patient with a recent history of cutaneous furunculosis. This 29-year-old male presented with an occipital headache associated with fever, vomiting, and neck stiffness. Admission magnetic resonance imaging showed a retrocerebellar epidural abscess. Antimicrobial therapy was started, and the patient underwent craniectomy for evacuation of the abscess. Cultures of the surgical specimen were consistent with CA-MRSA. Postoperatively, the patient's condition improved with the resolution of symptoms, and he was discharged home with indication of 6 weeks of antibiotic therapy. Furunculosis is a very rare cause of intracranial epidural abscess but should be considered as a source of infection in an immunocompetent patient.

A 70-year-old Spanish man was referred to our emergency room (ER) for acute generalized epileptic seizures, which had developed over the previous 24 h. Two years before, the patient had been diagnosed with multiple nocardial brain abscesses that had been successfully treated without recurrence and

There have been infrequent reports of isolated central nervous system blastomycosis. We report a case of intracranial epidural abscess secondary to Blastomyces dermatitidis in a patient residing in Rhode Island with a history of remote travel to an endemic area. The clinical, radiographic, and pathologic features of this unique case are reviewed.

Dental infection as a cause of epidural abscess is rare compared with other forms of intracranial suppurations. A 10-year-old boy was seen because of headaches and fever. There was no history of otitis media or sinusitis, but he had sought care for dental complaints. The patient was from an upper-middle-class family, was not immunocompromised, and had no other risk factor for a major infection. A CT brain scan confirmed a frontal epidural abscess. The patient underwent emergency surgery for evacuation of the epidural abscess, followed by antimicrobial therapy. His condition improved remarkably following surgery, with complete resolution of symptoms. He subsequently underwent extraction of 2 teeth following dental review. Dental infection as a cause of intracranial epidural abscess is rare, but should be considered when evaluating patients for intracranial infections. A review of the literature sheds light on the causal relationship and possible pathogenesis of this condition.

A 13-year-old boy with medically intractable sinusitis-related intracranial epidural abscess in the frontal region was treated using percutaneous tapping. Drainage of pus measuring 7 ml yielded excellent postoperative course without cosmetic disadvantage on the forehead. Percutaneous tapping is considered to be the ideal treatment because of minimal invasiveness and cosmetic aspects of the wound.

WOS: 000252089700012 PubMed: 18071992 Isolated sphenoid sinus infection, although an uncommon entity, can cause severe cranial complications when left untreated. A case of temporal epidural abscess secondary to isolated sphenoid sinusitis in a 13-year-old boy is presented. Early diagnosis and treatment are critical because the disease can progress rapidly.

1 Introduction 2 Intracranial Abscess (Brain Abscess) 3 Subdural Empyema and Intracranial Epidural Abscess 4 Spinal Epidural Abscess Keywords: other CNS bacterial infections; focal pyogenic infections of central nervous system (CNS) and life-threatening conditions; intracranial abscess (brain abscess); brain abscess bacteriology; C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR); empiric antimicrobial therapy in brain abscess; subdural empyema and intracranial epidural abscess; bacterial isolates and antibiotic therapy for spinal epidural abscess

Brain abscess, subdural empyema, and intracranial epidural abscess are three of the most commonly encountered focal suppurative processes of the central nervous system. A great deal has been known about the epidemiology and pathogenesis of these entities for quite some time, but until recent years the associated morbidity and mortality remained very high. New imaging techniques have allowed for more rapid detection and more precise localization of these lesions for surgical drainage. Empiric antimicrobial regimens that are effective within the abscess environment and that are directed against the most likely pathogens have also contributed to the improved outcomes seen in the current literature. This article will discuss some of the more recent advances in the diagnosis and treatment of these suppurative lesions within the central nervous system.

A 76-year-old female with an intracranial epidural abscess having a long history of about 30 years is presented. Craniogram, carotid angiogram, and computed tomographic scan showed a huge calcified lesion with hyperostosis at the right parietal region. The abscess appeared to have granulated and calcified due to long-lasting stagnation of the pus.

Intracranial epidural abscess is an uncommon but potentially life-threatening condition requiring prompt recognition and management. Most commonly it arises secondary to infection in the paranasal sinuses, mastoid air cells or the middle ear. It has also been described following craniotomy and trauma. This report describes three cases reported to our institution over a 15 month period, two associated with frontal sinusitis and one with no obvious predisposing factor.

Intracranial epidural abscess is a serious infection which constitutes a recognised neurosurgical emergency. Most commonly it is caused by spread of infection from the para-nasal sinuses, middle ear or mastoid. Post-craniotomy infection or compound skull fractures can result in an osteomyelitis and hence lead to the formation of an epidural collection. The abscess cavity is often too small to produce clinical evidence of impaired cerebral function. However, if not diagnosed and treated early enough, serious intracranial complications may arise. We report a case of epidural abscess presenting with raised intracranial pressure, and stress the value of CT scanning in the early diagnosis and in the follow-up of such cases. A 13-year-old schoolboy presented with two weeks' history of a tender fluctuating swelling overlying the centre of his forehead. Two months earlier he had complained of throbbing headache on physical activity, felt unwell, and suffered head colds with complicating sinusitis. Because of the ...