Pediatric headache patient with cerebral abscesses: a brief review of the literature and case report

• Published in: Journal of international medical research 2023-11, Vol.51 (11), p.3000605231213751-3000605231213751
• Main Authors: Bengio, Moshe, Goodwin, Glenn, Roka, Abhishek, Marin, Michelle
• Format: Article
• Language: English
• Subjects: Abscesses; Case Report and Case Series; Emergency medical care; Headaches; Pediatrics
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/03000605231213751

Abstract Background Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented. Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. Conclusion Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.