Picture quiz: Cerebral abscess

Case history

An 82 year old woman was admitted as an emergency, having had a generalised tonic-clonic seizure witnessed by her husband. She had no prior history of epilepsy and no history of trauma. According to her husband she was reasonably well and had not seen a doctor for more than 20 years.

She had no history of any drug allergy and was not taking any regular medication. She was a lifelong non-smoker and infrequent social drinker.

On admission she was found to have a fever, at 38oC, and her level of consciousness was impaired (Glasgow coma scale 6/15). Examination of her cardiorespiratory and abdominal systems was unremarkable. She was noted to have a large boggy abscess immediately behind her left ear. On further inquiry her husband acknowledged that she had a “sore” behind her left ear that had been present for …