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1108 - Acute Encephalopathy and Hemiparesis Secondary to Pott’s Puffy Tumor in an Adolescent Male: A Case Report.

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

LN

Linda Nwumeh, BA

MS4
Medical College of Wisconsin
West Allis, Wisconsin, United States

Co-Author(s)

TA

Talha Ahmad, BS

MS4
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
RS

Ryan Shields, MD

PGY-3, Physical Medicine in Rehabilitation
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
KZ

Kimberley Zvara, MD

Associate Professor of Physical Medicine and Rehabilitation
Medical College of Wisconsin
Milwaukee, Wisconsin, United States

Case Diagnosis: Pott's Puffy Tumor is a rare osteomyelitis of the frontal bone most common in adolescents, with inciting etiologies of frontal sinusitis or head trauma. Forehead swelling, fever, and headache are classical symptoms, and literature suggests mortality rates from intracranial complications of 12%.

Case Description: A 15-year-old male with a past medical history of asthma presented to the emergency department with fever, left-sided facial swelling, altered mental status, and headache after previously presenting two days prior and being diagnosed with viral upper respiratory infection. Upon transfer to acute care pediatric hospital due to CT head concerning for subdural empyema, MRI brain findings revealed Pott's Puffy Tumor with intracranial extension. This was found to be complicated by bacterial meningitis. Intravenous broad-spectrum antibiotics were initiated and he remained intubated and sedated, requiring pressor support. Subsequently, he underwent functional endoscopic sinus surgery with left-sided burr holes and right subperiosteal abscess incision and drainage. Post-operative course was complicated by right-sided hemiparesis, acute moderate encephalopathy, and delirium. On post-operative day eight, he experienced a focal seizure. Following resolution of delirium and encephalopathy, this patient experienced near-resolution of hemiparesis following rehabilitation and discharged home at functional baseline on post-operative day thirty-three.

Discussions: To our knowledge, hemiparesis has not been reported as a complication of Pott's Puffy Tumor or treatment. The post-operative onset of right-sided hemiparesis after left-sided burr hole drainage suggests a possible iatrogenic etiology, however, postoperative changes with the potential to explain this finding were not visualized on serial quick brain MRI studies. The acute encephalopathy and the focal seizure in this case were thought to be secondary to the intracranial extension of the infection.

Conclusions: This case demonstrates the potential for remarkable functional recovery of hemiparesis following standard of care surgical management of a severe case of Pott’s Puffy Tumor with early rehabilitative care.