Dados do Trabalho

Título

Focal epileptic seizure caused by brain abscess in the precental gyrus in Immunocompetent Host - A Case Report

Apresentação do caso

Female patient, 35 years old, previously healthy, allergic to penicillin. Presented to the Emergency Room with progressing neurological symptoms from 3 days before, when she had woken up with paresthesias in the right upper limb, which had an autolimited episode of involuntary movements. Incidence of a focal motor epileptic seizure beginning in the right upper limb and subsequently evolving into a right hemibody tonic-clonic seizure with duration of twenty minutes before resolution with 5mg of intramuscular Midazolam. Over the next 3 days, she presented hypoesthesia of the right hemiface, upper limb and hemiabdomen supraumbilical region and grade 4 right hemiparesis sparing the face. No more seizures occurred after the initiation of Carbamazepine 600mg/day. Laboratory analyses were negative to infectious markers. Echocardiography showed patent foramen ovale (PFO). Cranial neuroimaging showed a subcortical expansive lesion in the left precentral gyrus with a pattern compatible with cerebral abscess and scalp EEG evidenced epileptiform paroxysms in the left central region (no seizures captured). Empiric antibiotic regimen was initiated and posterior drainage surgery of the abscess. Microbiological culture was positive for Streptococcus intermedius, a gram-positive coccus that belongs to our usual microbiota. The patient completed 21 days of intravenous antibiotic treatment with Ceftriaxone and Metronidazol nand exhibited subtotal recovery from the initial neurological deficits. Control studies performed recently showed normalization of previous lesions.

Discussão

Brain abscesses are collections of focal purulent material within the brain parenchyma secondary to bacterial infections. In the present case, this lesion caused an alteration in the electrical activity of the brain, leading to a focal onset seizure. For this diagnosis, it’s mandatory to have a well collected clinical history. The MRI and EEG posteriorly confirmed the presence of an expansive lesion.

Comentários finais

Epilepsy is considered a common complication of brain abscess and most patients with this condition undergo prophylactic convulsant therapy. The incidence of seizures is approximately 35% in most reported studies. However, the occurrence of a brain abscess in an immunocompetent host is a very rare disturbance. Regarding this case, the PFO may have contributed to the bacterial infection of the brain, probably due to an oral mucosa infection hematogenously disseminated.