Odontogenic brain abscess – Prevotella loescheii a rare sinunasal spread of infection

Introduction With an incidence of 0.3-1.3 cases/ inhabitant per year, brain abscesses are epidemiologically a rare disease. But nevertheless, with a mortality rate of 10-15 % still a serious disease. The main etiological triggers are streptococci, enterococci, bacteroides species and staphylococci. We report about the rare case of odontogenic spead of infection.

Methods Case report of a 32-year-old patient with an odontogenic brain abscess.

Case report The patient had been describing progressive cephalgia for about six weeks and acute nausea. This was preceded by a tooth extraction with a mouth-antrum connection and subsequently a maxillary sinus empyema on the right side, which was relieved.

Clinically, there were signs of acute sinusitis on the right side. A first blood sample showed a leukocytosis (14.24 g/ l) and CRP increase (62.95 mg/ l). The following CT scan of the paranasal sinuses confirmed a sinusitis with breakthrough of the right frontal sinus. Cranial MR imaging confirmed a pronounced brain abscess. There was an emergency pansinus surgery on the right side. The next day the brain abscess was relieved by a craniotomy. The smear test of the sinus cavity showed Prevotella loescheii.

Discussion In our case report we described a rare spread of germs with brain abscesses caused by Prevotella after a dental surgery. The patient’s acute symptoms (massive cephalgia and nausea) were initially incorrectly classified, and the patient was placed in an outpatient setting. To be on the safe side cases of cephalgia and focal neurological deficits after dental surgery, imaging should always be carried out. The patient was discharged in good general condition with oral antibiosis for four weeks; a follow-up examination is still pending.

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Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publication History

Article published online:
13 May 2021