Abstracts

Rationale: A fifteen year old Hispanic patient with medical history of penicillin allergy was otherwise previously healthy. He was admitted to this hospital because he suddenly presented aphasia.Methods: Approximately 8 days before admission he complained of a headache 8 at of 10 in the frontal region predominately on the left side. He was taking ibuprofen but the pain persisted. 2 days after, he presented fever of 38.8c. He persisted with the previously symptomatology. One day before admission he had periorbital cellulitis and was incapable communication, but his sensorial comprehension was not altered. On admission and upon examination we found a fifteen-year-old male, Hispanic. He had fever 38c (104F), tachycardia (120 bpm), was awake, obeying commands, had adequate ocular movements and we could not find any cranial nerve involvement. Muscle strength was 5/5 on all extremities with normal reflexes, but with Indifferent plantar reflexes. There where not signs of clinical meningitis no kerning, or brudznzki. A CT scan was ordered in the emergency room and showed the maxilar and frontal left sinus occupied. An LP was performed, reporting 71 proteins, 48 cellularity per mm3, 14 Leucocytes, 45% mononuclears and 55% polymorphonuclears, glucose 83mg/dl. Results: Because the physical exploration indicated periorbital cellutis, antibiotics where initiated. An EEG show spike and wave and polysipke on F7-T3, T3-T5. After that the patient was started with 10mg of diazepam with abrupt improvement motor speech. Another CT scan was order but with contrast this time, and didn t yield any new images. We initiated carbamazepine in order to control the seizures. A brain MRI (1.5T) showed frontal and maxilar sinusitis predominately the left side and a cyst appearance on the left frontal lobe. Also, a hyper-intense area on the interhemispheric fissure. Conclusions: The patient was treated with ceftriaxone, vancomycin and metronidazole for 5 days but he complained of a headache in the frontal region. Another brain CT scan was performed, showing the previously lesion described on the MRI but with an increase in size. The patient had a neurosurgical intervention with drainage of a brain abscess and subdural empyema. After 10 days of treatment, patient started having fever and a headache, the culture was negative; a new antibiotic regime was initiated with impimen and vancomycin with improvement 48 hours after the initiated treatment. The patient completed treatment and was discharged with carbamazepine 200mg every 8 hours and continues as an outpatient with MRI follow-ups.