SHM Converge Scientific Abstract ePoster Gallery-Frontal Bone Osteomyelitis With Direct Intracranial Spread Presenting as Recurrent Brain Abscess

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This case describes a 65-year-old man with myelodysplastic syndrome who presented after a welfare check with altered living conditions, slurred speech, facial asymmetry, and left leg weakness. He was afebrile and hemodynamically stable, with no prominent systemic signs of infection despite having a serious intracranial process.<br /><br />Imaging revealed a large right frontal brain abscess with marked vasogenic edema and significant midline shift. Further CT of the facial bones showed severe frontal bone osteomyelitis with erosion of the posterior frontal wall and direct communication into the intracranial space, along with bilateral medial orbital wall erosion. The patient had important risk factors, including prior brain abscess from a dental infection, chronic sinus disease, and previous craniofacial surgery.<br /><br />He underwent right frontal craniotomy with neuronavigation for surgical source control. The case illustrates how frontal osteomyelitis, a rare complication of sinusitis and sometimes associated with Pott’s puffy tumor, can lead to direct intracranial spread and recurrent brain abscess. In immunocompromised patients such as those with MDS, fever and leukocytosis may be absent because of a blunted inflammatory response.<br /><br />The authors emphasize that persistent bony erosion and sinus communication can cause recurrent infection unless the underlying source is treated. Key lessons include maintaining suspicion for chronic sinus-related disease in recurrent intracranial infections, obtaining early neuroimaging, and pursuing multidisciplinary management with surgical intervention to improve outcomes.

Asset Subtitle

Seyfe B. Tilahun

Meta Tag

Author List Bradlee Palmquist, Danielle Uibel, Seyfe B. Tilahun, Syed Nazeer Mahmood

Category Clinical Vignettes

Concept Frontal Bone Osteomyelitis

Concept Cerebral Abscess

Concept Intracranial Spread

Concept Sinus Disease

Concept Intracranial Infection

Distinguished Non-Finalist

Presenter Organization Bayhealth Medical Center

Presenting Author Seyfe B. Tilahun

Track Adult

Keywords

myelodysplastic syndrome

brain abscess

frontal osteomyelitis

sinusitis

intracranial infection

midline shift

vasogenic edema

craniotomy

Pott's puffy tumor

immunocompromised

Frontal Bone Osteomyelitis

Cerebral Abscess

Intracranial Spread

Sinus Disease

Intracranial Infection