Objective
The aim of this study was to answer the following clinical question: “In patients
admitted to a tertiary care hospital with a diagnosis of brain abscess, how common
is odontogenic etiology?”
Study Design
We designed a retrospective study of patients with brain abscesses diagnosed at the
Massachusetts General Hospital between 1980 and 2017. Inclusion criteria were complete
medical records outlining clinical course, relevant dental history, and radiographic
and microbiologic data.
Results
Of 167 intracranial abscesses, 88 (52.7%) originated from a head/neck source, and
12 (13.6%) were of odontogenic etiology. Dental radiographs in 7 cases showed active
dental infection. The remaining 5 patients reported recent dental procedures. Frontal
lobe localization was the most common (7 of 12 [58.3%]). Presenting signs included
headache (66.7%), mental status changes (41.6%), visual deficits (41.6%), and speech
difficulties (33.3%). Computed tomography (CT) or magnetic resonance imaging (MRI)
confirmed all diagnoses. Drainage via open craniotomy was performed in 6 (50%) of
12 patients, and stereotactic CT-guided drainage in 4 (33.3%). The most common pathogens
were Streptococcus milleri (45.5%), Staphylococcus species (27.3%), and Fusobacterium (27.3%). All cases had favorable outcomes. Five had residual neurologic deficits,
4 had persistent visual complaints, and a recurrent abscess developed in 1 case.
Conclusions
These findings showed a higher subset (13.6%) of brain abscesses that could be attributed
to odontogenic etiology than previously reported in the literature and highlight the
need to rule out dental sources in cryptogenic cases.
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Article info
Publication history
Published online: May 03, 2020
Accepted:
January 20,
2020
Received in revised form:
December 15,
2019
Received:
October 7,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
