BRAIN ABSCESSES FOLLOWING DENTAL INFECTIO NS

Brain abscess following dental or periapical infection is rare in chil dhood. This report describes brain abscesses found in two children wit h dental caries. Case 1. - A 12 year-old boy was admitted because he h ad suffered from acute meningitis for 3 days. Clinical examination sho wed symptoms of meningitis plus palsy of the right third and fourth cr anial nerves and of the left facial nerve, and a defect in the left te mporal field. Funduscopic examination showed papilledema; CT scan and MRI showed a ring-shaped lesion in the right occipital area. The patie nt was given cefotaxime and thiamphenicol. The abscess was drained; ba cteriological examination showed Actinomyces viscosus and Peptostrepto coccus magnus. The neurological condition and the CT scan lesion impro ved, but intracranial pressure increased again on the 17th day after t he onset, requiring replacement of the antibiotics by rifampicin and a mpicillin plus clavulanic acid for 2 months. This brain abscess appear ed to be metastatic, derived from the infection of a large dental cyst due to a dental infection that had been treated 6 months earlier. Cas e 2. - A 8 1/2 year-old girl was admitted because she was suffering fr om palsy of the left facial nerve and left arm. She had had headaches and fever for a few days. Clinical examination showed the palsies adn drowsiness. CT scan showed two brain abscesses. The patient was given ceftriaxone, fosfocin and metronidazole. She had been treated for a gi ngival abscess 1 month earlier, and had two infected teeth extracted. Improvement of the intracranial pressure was transient and the antibio tics were changed on the 12th day of treatment. The patient was given thiamphenicol for 2 weeks and ceftriaxone plus rifampicin for 6 weeks. Conclusion. - Brain abscesses in childhood can be due to the spread o f foci of dental infection. Organisms were not found in the dental foc i but those found in the brain abscess of case n degrees 1 were normal oral cavity saprophytes.