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Abstract Details

Noninvasive Managment of a Pontomedullary Abscess
Infections/AIDS/Prion Disease
P03 - (-)
254
BACKGROUND: Pontomedullary abscess is a very uncommon condition. Over the previous years brainstem abscesses have resulted in fatal events due to nonavailability of appropriate diagnostic measures. We report a case which demonstrates the effective use of long-term intravenous antibiotics in successfully treating a brainstem abscess.
DESIGN/METHODS: 43 year old male with a past history of dental caries presented to the Emergency Room with right-sided weakness, dysarthria, fevers and chills for one week. On exam patient had right sided weakness, facial droop, headache and blurry vision. Patient's dental hygeine was poor as he had untreated infected dental caries. Computed Tomography scan showed no abnormalities and spinal fluid was negative for any organisms. Brain MRI showed a signal abnormality in the left pons and upper medulla, consistent with an abscess. Infectious disease team was consulted and a nonsurgical approach was advised. Patient then received 93 days of intravenous antibiotics including Ceftriaxone, Vancomycin, Metronidazole. Repeat MRI at a three month neurology follow up appointment showed resolution of the brainstem abscess. The patient's symptoms also showed marked improvement.
RESULTS: Our study demonstrates the significance of long-term antibiotics for managment of brainstem abscesses after MRI has confirmed the diagnosis. It is vital to correlate the patient's past history with the findings of a brainstem abscess on diagnostic imaging. Treating the primary source of infection assists in patient's recovery and prevents having to opt for surgical intervention.
CONCLUSIONS: Prolonged use of intravenous antibiotics is an effective tool in non-invasively treating brainstem abscesses. Medical management avoids surgical intervention, which may further introduce pathogens and complicate the potentially fatal condition.
Authors/Disclosures
Iftekhar Ahmed, MD, PC, FAAN (HCA)
PRESENTER 		Dr. Ahmed has nothing to disclose.
Robert Zivadinov, MD, PhD, FAAN (Buffalo Neuroimaging Analysis Center) The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Omnicuris. The institution of Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Myrobalan. Dr. Zivadinov has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Zivadinov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Zivadinov has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bristol Myers Squibb. The institution of Dr. Zivadinov has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen.
No disclosure on file
Seher H. Anjum, MD (UMKC Internal Medicine) No disclosure on file
Steven C. Kosa, MD, FAAN (Meritas Health Neurology) Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for AbbVie. Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lily . Dr. Kosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Impel. Dr. Kosa has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biohaven/Pfizer. Dr. Kosa has received research support from Eli Lily .