Young patient with headache and walking difficulty for the USMLE
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