Case Report
Multiple brain abscesses in an immunocompetent patient after undergoing professional tooth cleaning

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ABSTRACT

Background.

Dental disorders and dental treatment are among the variety of causes of brain abscess.

Case Description.

The authors present the case of a patient who developed multiple brain abscesses after undergoing professional tooth cleaning. The results of a diagnostic work-up ruled out an underlying immunodeficiency. After receiving neurosurgical intervention and intensive care treatment by means of local and intravenous antibiotics for 24 days, the patient was transferred to another hospital for rehabilitation. Six months after the treatment, the patient still had moderate residual paresis of the left leg.

Practical Implications.

Although it happens rarely, professional tooth cleaning may be considered a cause of brain abscesses even in otherwise healthy patients.

Section snippets

CASE REPORT

The patient, a 55-year-old man, sought care at a medical center because he had experienced an acute onset of weakness in his left leg. Until then, he had been in good health and had no known pre-existing conditions. The patient reported that he had received a professional tooth cleaning from his dentist 10 days before he was transferred from the medical center to our hospital (University Hospital of Dresden, Germany). He also reported that he began shivering later on the day he had his teeth

DISCUSSION

A brain abscess is rare but life threatening. It consists of a focal cerebral infection surrounded by a well-vascularized capsule. Its clinical presentation is highly variable and depends on the size and location of the abscess, the virulence of the infectious organism and the presence of pre-existing conditions.4 Typical symptoms are headache, nausea, vomiting and an impaired level of consciousness.5, 6 In addition to either a direct infection occurring after experiencing a penetrating head

CONCLUSION

This case we present suggests that, in individual cases, prophylactic professional tooth cleaning may cause transient bacteremia that may lead to brain abscesses even in patients who are immunocompetent. Specific precautions are not known. Treatment of these patients should be interdisciplinary and involve neurologists, neurosurgeons, dentists and oral and maxillofacial surgeons.

References (23)

  • MR Azenha et al.

    Multiple brain abscess from dental origin: case report and literature review

    Oral Maxillofac Surg

    (2012)
  • Cited by (0)

    Disclosure. Dr. Reichmann has sat on advisory boards for, given lectures on behalf of and received research grants from Abbott, Bayer Health Care, Boehringer/Ingelheim, Brittania, Cephalon, Desitin, GSK, Lundbeck, Merck-Serono, Novartis, Orion, Pfizer, TEVA, UCB Pharma and Valeant. None of the other authors reported any disclosures.

    1

    Dr. Pallesen is a resident and a neurologist, Department of Neurology, Technical University Dresden, Fetscherstraße 74, 01307 Dresden, Germany

    2

    Dr. Schaefer is a senior physician and a neurologist, Department of Neurology, Technical University Dresden, Germany.

    3

    Dr. Reuner is a senior physician and a neurologist, Department of Neurology, Technical University Dresden, Germany.

    4

    Dr. Leonhardt is a resident, Department of Oral and Maxillofacial Surgery, Technical University Dresden, Germany.

    5

    Dr. Engellandt is a senior physician, Department of Neuroradiology, Technical University Dresden, Germany.

    6

    Dr. Schneider is a senior physician and a neurologist, Department of Neurology, Technical University Dresden, Germany.

    7

    Dr. Reichmann is a professor and the chair, Department of Neurology, and the dean of the medical faculty, Technical University Dresden, Germany.

    8

    Dr. Puetz is a senior physician and a neurologist, Department of Neurology, Technical University Dresden, Germany.

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