INTRACRANIAL PARASAGITTAL EPIDURAL ABSCESS: ANOTHER CONSIDERATION FOR THE ETIOLOGY OF ACUTE HEADACHE AND FEVER FOLLOWING A MINOR HEAD INJURY

A previously healthy seven-year-old girl, who suffered a minor head injury, experienced diagnostic complications spanning two weeks, resulting from an intracranial epidural abscess. Originally diagnosed with cephalgia and a urinary tract infection, which were unresponsive to antibiotics, secondary workup revealed a large bifrontal epidural lesion. She was transferred to our neurosurgery services for further management and workup of the lesion. Magnetic resonance imaging demonstrated an enhancing anterior parasagittal fluid collection that was suggestive of an infection. Burr-hole surgery directly over the lesion confirmed the diagnosis of brain abscess. Irrigation and drainage was done, and her recovery was rapid and uncomplicated with the subsequent treatment with appropriate antibiotics. A possible etiology for this unusually located abscess is that the patient had a hemorrhage into this location from the initial injury. This subsequently became infected after a urinary tract infection or sinusitis. This case may be a useful reference for identifying patients with a brain abscess after a minor head injury, this occurring without direct invasion of the region of concern with a known foreign body, the usual mechanism after a traumatic brain injury.