Pediatric Infectious Disease

Register      Login

VOLUME 5 , ISSUE 2 ( April-June, 2023 ) > List of Articles

CASE REPORT

A Treatable Cause of Cerebral Palsy: Brain Abscess Masquerading as Cerebral Palsy

Vykuntaraju K Gowda, Shanti Bhusan Mohanty, KVN Dhananjaya

Keywords : Brain abscesses, Cerebral palsy, Hypoxic–ischemic encephalopathy, Infant

Citation Information : Gowda VK, Mohanty SB, Dhananjaya K. A Treatable Cause of Cerebral Palsy: Brain Abscess Masquerading as Cerebral Palsy. Pediatr Inf Dis 2023; 5 (2):52-55.

DOI: 10.5005/jp-journals-10081-1378

License: CC BY-NC 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Introduction: A brain abscess is an intraparenchymal collection of pus in the brain. Cerebral palsy (CP) is a static encephalopathy due to injury to the developing brain. CP is a group of disorders due to multiple etiologies. We are reporting a rare cause of brain abscess presenting as CP. Case description: A 12-month-old boy presented with a developmental delay with perinatal depression. He had attained only partial head control. On examination, head size was 42.5 cm between –2SD and –3SD, and tone was increased in both spasticity and dystonia with exaggerated deep tendon reflexes. On investigations, complete blood count, liver function test, and renal function test were normal. Magnetic resonance imaging (MRI) of the brain showed two ring-enhancing lesions in the left frontal and right temporoparietal lobe. The cerebrospinal fluid (CSF) showed two lymphocytes, protein of 32 mg/dL, and glucose of 60.1 mg/dL. Due to nonreduction in size of the abscess on repeat MRI of the brain after 4 weeks of intravenous antibiotics, the child underwent burr hole aspiration of abscess in the left frontal lobe. The intravenous antibiotics continued for another 4 weeks. On follow-up, computed tomography (CT) of the brain showed a reduction in the size of brain abscesses with calcification. The child attained a social smile, reached for objects, and his tone was improved. Conclusion: For any child presenting with developmental delay with perinatal history of hypoxic–ischemic encephalopathy (HIE), neuroimaging should be done as it gives important clues for etiology and helps in specific management and prognosis.


HTML PDF Share
  1. Sharma BS, Gupta SK, Khosla VK. Current concepts in the management of pyogenic brain abscess. Neurol India 2000;48(2):105–111. PMID: 10878771.
  2. Gowda VK, Kumar A, Shivappa SK, et al. Clinical profile, predisposing factors, and associated co-morbidities of children with cerebral palsy in South India. J Pediatr Neurosci 2015;10(2):108–113. DOI: 10.4103/1817-1745.159191
  3. Molinari GF, Smith L, Goldstein MN, et al. Brain abscess from septic cerebral embolism: an experimental model. Neurology 1973;23(11):1205–1210. DOI: 10.1212/wnl.23.11.1205
  4. Brouwer MC, Tunkel AR, McKhann 2nd GM, et al. Brain abscess. N Engl J Med 2014;371(5):447–456. DOI: 10.1056/NEJMra1301635
  5. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology 2014;82(9):806–813. DOI: 10.1212/wnl.0000000000000172
  6. Luthra G, Parihar A, Nath K, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 2007;28(7):1332–1338. DOI: 10.3174/ajnr.A0548
  7. Gupta RK, Nath K, Prasad A, et al. In vivo demonstration of neuroinflammatory molecule expression in brain abscess with diffusion tensor imaging. AJNR Am J Neuroradiol 2008;29(2):326–332. DOI: 10.3174/ajnr.A0826
  8. Mishra AM, Gupta RK, Jaggi RS, et al. Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr 2004;28(4):540–547. DOI: 10.1097/00004728-200407000-00017
  9. Garg M, Gupta RK, Husain M, et al. Brain abscesses: etiologic categorization with in vivo proton MR spectroscopy. Radiology 2004;230(2):519–527. DOI: 10.1148/radiol.2302021317
  10. O'Connor C, Collins A, Twomey E, et al. A case report of multiple cerebral abscess formation complicating serogroup B Neisseria meningitidis meningitis. BMC Infect Dis 2019;19(1):863. DOI: 10.1186/s12879-019-4509-y
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.