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Case Reports
. 2015 Apr 13:2015:bcr2014207548.
doi: 10.1136/bcr-2014-207548.

Actinomyces meyeri brain abscess following dental extraction

U Clancy  1 , A Ronayne  1 , M B Prentice  1 , A Jackson  2
Affiliations
Case Reports

Actinomyces meyeri brain abscess following dental extraction

U Clancy et al. BMJ Case Rep. .

Abstract

We describe the rare occurrence of an Actinomyces meyeri cerebral abscess in a 55-year-old woman following a dental extraction. This patient presented with a 2-day history of hemisensory loss, hyper-reflexia and retro-orbital headache, 7 days following a dental extraction for apical peridonitis. Neuroimaging showed a large left parietal abscess with surrounding empyema. The patient underwent craniotomy and drainage of the abscess. A. meyeri was cultured. Actinomycosis is a rare cause of cerebral abscess. The A. meyeri subtype is particularly rare, accounting for less than 1% of specimens. This case describes an unusually brief course of the disease, which is usually insidious. Parietal lobe involvement is unusual as cerebral abscesses usually have a predilection for the frontal and temporal regions of the brain. Although there are no randomised trials to guide therapy, current consensus is to use a prolonged course of intravenous antibiotics, followed by 6-12 months of oral therapy.

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Figures

Figure 1
Figure 1
Initial CT of the brain with contrast.
Figure 2
Figure 2
MRI of the brain with gadolinium contrast.
Figure 3
Figure 3
MRI post-gadolinium—sagittal view.
Figure 4
Figure 4
Interval CT of the brain with new frontal collection.
See this image and copyright information in PMC

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