Brain abscesses in children are rare, but can lead to severe complications, especially if they are not recognized and treated promptly.
We present the clinical case of a four-year-old girl who was admitted in the Second pediatric clinic at St. Marina University hospital in Varna because of attacks of severe frontal headache, sometimes accompanied by vomiting. The child was first hospitalized at the Infectious disease clinic for a bacterial intestinal infection, but during the hospital stay the attacks became more frequent. After the child was discharged, the parents noticed that the movements of the left limbs were severely impaired, with the left leg being swayed during walking. At the Second pediatric clinic, the child was conscious, afebrile, with normal general exam, but with pronounced syndrome of meningeal irritation and with left hemiparesis. Blood tests showed evidence of bacterial infection. Computed tomography was performed, where a large cystic formation (70/50 mm) was visualized in the right cerebral hemisphere, corresponding to an abscess with severe dislocation, requiring surgery to be performed urgently. The child had a smooth post-operative period, with no evidence of infection and no seizures. The focal neurological signs regressed over the following few days. A repeat CT scan of the head showed complete evacuation of the abscess and reduction of the edema. The girl was discharged on the fifteenth day, in good overall condition, with no headaches, and with fully restored motor activity.
We discuss the diagnosis, differential diagnosis, the role of timely imaging and the treatment applied for the good prognosis of the patient.
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