Brain Abscess in a Patient With Radiotherapy-Treated Adenoid Cystic Carcinoma: A Misdiagnosis Case Report and Review of the Literature

Brain abscesses are a relatively rare entity with an estimated incidence of 0.3 to 1.3 per 100,000 people per year. Brain abscesses arise from direct contiguous spread, hematogenous spread, neurosurgical procedures, open traumatic brain injuries, and cryptogenic sources. Early identification is pivotal, as delayed diagnosis and treatment lead to a very poor prognosis. Our case illustrates an elderly gentleman with a history of adenoid cystic carcinoma (ACC) of the oropharyngeal palate who presented to an outside hospital with severe headaches and was found to have a questionable metastatic lesion to his left temporal region. He was discharged with a course of steroids. Weeks later his headaches persisted, mentation further declined and repeat imaging revealed the same abnormal lesion. He subsequently underwent a craniotomy and was found to have a significant temporal abscess and empyema, which were evacuated. Post-operatively his course was complicated by status epilepticus requiring intubation and he was ultimately placed on hospice care. Our case illustrates the importance of early recognition and intervention for suspicious lesions, particularly when predisposing risk factors exist. J Neurol Res. 2020;000(000):000-000 doi: https://doi.org/10.14740/jnr620