Young patient with headache and walking difficulty for the USMLE

by / Friday, 13 August 2010 / Published in Pediatrics

Any young patient that presents with a headache + difficulty walking (or any other focal neurological problem) should be suspect of a BRAIN ABSCESS.

The onset of a headache followed by neuro deficits soon thereafter an episode of acute otitis media is very suggestive of a brain abscess.

  • Headaches are the MC symptom of brain abscess, but are quite non-specific
  • Fever is NOT a reliable sign for brain abscesses because they are only seen 50% of the time
  • Papilledema is a later sign and indicates significant cerebral edema (seen in approximately 25% of patients)
  • The onset of focal neurological deficits occurs in 50% usually days to weeks after the onset of headaches.

Diagnosing:  A CT or MRI will show a ring-enhanced lesion

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