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Cerebral abscess in pregnancy: a clinical dilemma
  1. N Salvi,
  2. N Massiah,
  3. ID Nuttall
  1. Stepping Hill Hospital, Stockport, UK

Abstract

A 19-year-old at 39 weeks gestation had caesarean delivery for pathological cardiotocograph at 2 cm cervical dilatation. Antenatal, intrapartum and postpartum blood pressures did not exceed 140/90 mm Hg. On first postnatal day, she had a seizure and was commenced on magnesium sulphate. She had persistent headaches, no epigastric pain nor visual disturbances and no proteinuria. A multidisciplinary approach was taken involving anaesthetist and neurologist. On day 4, she developed fever and was started on antibiotics. As CT scan performed on day 7 showed large frontal subdural empyema with abscess and midline shift, she was transferred to a neurosurgical tertiary centre. Intravenous antibiotics and oral dexamethasone were started. A right frontal craniotomy was performed with evacuation of empyema and abscess. She was discharged on 6 week course of intravenous antibiotics and antiepileptic drug for 2 years.

Discussion Cerebral abscess is a life threatening condition rarely associated with pregnancy. Predisposing factors include infection, foreign bodies and immunosuppression. Headache is present in 75%, focal neurological deficit in 67% and seizures in 17%. The treatment consists of antibiotics alone or with neurosurgical drainage depending on the size of abscess. Steroids reduce brain oedema. Anticonvulsants prevent seizure reoccurrence as neurosurgery can be ableptogenic. Mortality occurs in about 12% of alert patients, 60% in patients with herniation and about 90% in comatose.

Conclusion The presence of atypical features for eclampsia should alert the clinician to consider differential diagnoses of cerebral lesions. A delay in making the correct diagnosis can alter outcome and worsen prognosis.

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