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Images in Neurology
May 2013

Metastatic Epidural Bacterial Abscess in a 4-Year-Old Boy

Author Affiliations

Author Affiliation: Division of Child Neurology, Nationwide Children's Hospital, Columbus, Ohio.

JAMA Neurol. 2013;70(5):648. doi:10.1001/jamaneurol.2013.1942

A 4-year-old boy with community-acquired pneumonia unresponsive to outpatient antibiotics was admitted to the hospital for intravenous treatment. Chest computed tomography revealed left lower lobe pulmonary empyema (Figure 1), which led to the placement of a chest tube. After 1 week of intravenous antibiotics, the chest tube was removed and the patient was to be discharged home. Unexpectedly, the patient's clinical condition deteriorated. He became encephalopathic and had evidence of tonic eye deviation to the right. While undergoing an emergency computed tomographic scan of the head, the patient had a generalized tonic-clonic seizure. Head computed tomography revealed osteomyelitis of the left anterior, medial, and inferior frontal bone as well as left anterior, inferior, and medial epidural fluid collection suggestive of an epidural abscess. Brain magnetic resonance imaging with and without contrast confirmed the findings (Figure 2). The neurosurgeon performed an emergency hemicraniotomy and abscess evacuation; the surgical procedure was not associated with complications. Six months later, at a follow-up appointment, the patient had no evidence of neurological deficit.

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