E-ISSN 2534-9821
 

Case Report 


A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature

Debkumar Chowdhury.

Abstract
Introduction
Dealing with the clinical presentation of a patient with alternating level of consciousness can be challenging. A systematic approach is required and a wide set of differential diagnoses is needed to maximise the chances of a diagnosis. Intracranial (parenchymal) brain abscesses can have a varied presentation especially in the younger patent.
Case Presentation
A gentleman in his 40s was brought into the Emergency Department by his concerned parents with 3-day history of alternating consciousness and worsening head and neck pain over the preceding 24 hours. On clinical examination the Glasgow Coma Scale (GCS) altered between 14 (E4 M6 V4) to 13 (E4 M5 V4), he was only able to concentrate for a period of seconds prior to periods with his eye rolling upwards and then return to baseline GCS of 14. He had extensive neuro-imaging as initial CT Brain was noted to be inconclusive, Detailed MRI imaging revealed a large right frontal abscess. On an emergency basis he had frameless stereotactic biopsy of the right frontal abscess which grew Gram negative bacilli and was negative for Tuberculosis. He subsequently had an External Ventricular Drain inserted. He was treated with intravenous antibiotics and he subsequently improved following a prolonged of period of treatment.
Discussion
The main sources of brain abscess are from traumatic brain injury, as a sequela of neurosurgical procedures, spread from a local source or haematogenous spread from systemic infections. However, in a large proportion of cases no under aetiologies can be elicited. CT and MRI imaging remain the cornerstone of imaging for brain abscesses and where the diagnosis is equivocal these patients would undergo biopsy to assess the underlying cause. High clinical suspicion is needed as the abscess presentation can be variable and imaging modalities have limited specificities
Conclusion
Clinicians need to be aware of the varying presentations of intracranial abscesses, a life-threatening condition unless timely treated. The importance of early involvement of a multidisciplinary team approach to the management of such complex cases in order to optimise the chances of a favourable outcome for the patient. Early targeted therapy can be challenging especially if the diagnosis is equivocal, hence the requirement of early use of neuro-imaging to ascertain the underlying cause.

Key words: Glasgow Coma Scale (GCS), Intracranial abscess, Neuro-imaging


 
ARTICLE TOOLS
Abstract
PDF Fulltext
How to cite this articleHow to cite this article
Citation Tools
Related Records
 Articles by Debkumar Chowdhury
on Google
on Google Scholar


How to Cite this Article
Pubmed Style

Chowdhury D, . A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. Int J Med Rev Case Rep. 2020; 4(5): 111-115. doi:10.5455/IJMRCR.consciousness-ed-review


Web Style

Chowdhury D, . A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. http://www.mdpub.net/?mno=106408 [Access: July 15, 2020]. doi:10.5455/IJMRCR.consciousness-ed-review


AMA (American Medical Association) Style

Chowdhury D, . A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. Int J Med Rev Case Rep. 2020; 4(5): 111-115. doi:10.5455/IJMRCR.consciousness-ed-review



Vancouver/ICMJE Style

Chowdhury D, . A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. Int J Med Rev Case Rep. (2020), [cited July 15, 2020]; 4(5): 111-115. doi:10.5455/IJMRCR.consciousness-ed-review



Harvard Style

Chowdhury, D. & (2020) A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. Int J Med Rev Case Rep, 4 (5), 111-115. doi:10.5455/IJMRCR.consciousness-ed-review



Turabian Style

Chowdhury, Debkumar, and . 2020. A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. International Journal of Medical Reviews and Case Reports, 4 (5), 111-115. doi:10.5455/IJMRCR.consciousness-ed-review



Chicago Style

Chowdhury, Debkumar, and . "A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature." International Journal of Medical Reviews and Case Reports 4 (2020), 111-115. doi:10.5455/IJMRCR.consciousness-ed-review



MLA (The Modern Language Association) Style

Chowdhury, Debkumar, and . "A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature." International Journal of Medical Reviews and Case Reports 4.5 (2020), 111-115. Print. doi:10.5455/IJMRCR.consciousness-ed-review



APA (American Psychological Association) Style

Chowdhury, D. & (2020) A gentleman presents to the Emergency Department with alternating level of consciousness- A pictorial case study with review of the underlying literature. International Journal of Medical Reviews and Case Reports, 4 (5), 111-115. doi:10.5455/IJMRCR.consciousness-ed-review