We report a case of
brain abscess caused by a
penetrating head injury that occurred 9 years earlier. A 14-year-old girl presenting with
fever,
headache, and stiff neck was admitted to our hospital. She was diagnosed with
aseptic meningitis and treated conservatively. Seven days after admission she became stuporous and showed left
hemiparesis. Computed tomography (CT) revealed two ring-enhancing masses with perifocal
edema in the right frontal lobe. We diagnosed
brain abscess and performed right fronto-temporal
decompressive craniectomy and stereotactic aspiration, followed by systemic
antibiotic therapy. Post-surgery bone window CT revealed a well-defined, low-density
foreign body passing from the left orbita to the right frontal lobe through the ethmoid sinus. We learned that the patient had been struck with a
plastic chopstick in the left medial eyelid at the age of 5 years. No particular symptoms developed during the following 9 years. After the
cerebral edema had diminished over the next 10 days, a second surgery was performed to remove the residual chopstick, repair the
fistula at the base of the skull, and perform cranioplasty. The patient was discharged with only slight
hyposmia after a 4-week course of
antibiotics. This case showed that it is necessary to remove a residual
foreign body and to close the dural
fistula if there is a possibility of recurrent
central nervous system infection. When a child presents with
brain abscess, previous
penetrating head injury should be considered.