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Odontogenic infections can spread to any organ of the body and in some cases cause life threatening infections. We report a case of multiple odontogenic brain abscesses resulting from undetected tooth decay. Whereas most odontogenic brain abscesses occur following dental treatment, this report documents brain abscesses prior to dental treatment, signifying the dangers of covert dental infections. This case report updates the literature on the topic of odontogenic brain abscesses.Odontogenic infections are known to spread throughout the body and cause distant organ failure and life threatening infections (eg endocarditis, meningitis and Ludwig's angina).1-4 Brain abscesses are of particular concern because of the potentially debilitating sequelae. Their incidence in the US is cited as 1:100,000 annually. 3 The prevalence of odontogenic brain abscesses ranges between 3% and 10% of all cases. [5][6][7] Brain abscesses occur more frequently in men than in women. 5,7,8 Odontogenic brain abscesses in children are virtually unheard of. The advent of computed tomography (CT) technology and magnetic resonance imaging (MRI) has greatly improved the diagnosis of brain abscesses and consequently reduced the rate of mortality.5 However, the outcome of treatment is still haunted by death or permanent handicap. 8 The following case report serves as a salient reminder of this danger of untreated dental disease. case historyA 56-year-old man was taken to a remote hospital by his co-worker because he arrived at work looking unwell and had mental changes. The patient's medical history was significant for hypertension, cholecystectomy and obstructive sleep apnoea with lisinopril, losartan and furosemide as his daily medications. He had recently experienced a dry cough for more than one month that was attributed to lisinopril being added to his prescribed medications. At about the same time he developed an intermittent fever. One week before presentation he experienced tunnel vision and memory lapse of recent events. Over the one-month time period he had a headache that progressively grew worse. Five days prior to presenting at hospital he developed pain in his neck and back with nausea and vomiting. His wife reported that six months earlier he had a toothache on his left side that resolved without treatment.CT showed multiple intracranial mass effect lesions and hydrocephaly. Vancomycin, aciclovir and ceftriaxone were administered before the patient was flown to a level 1 trauma centre for a higher level of care with the suspicion of brain abscess versus neoplasm. There he was found to be sleepy but making intentional movements such as pulling out his urinary catheter. He moved all extremities spontaneously and withdrew from noxious stimuli. His pupils were sluggish to non-reactive and miotic. Nuchal rigidity was unclear. Aciclovir and lisinopril were discontinued and fluconazole was started.The patient had bilateral external ventricular drains inserted, was placed on mechanical ventilation, had a subclavian central cathete...

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Coordinating care among health care providers in a patient with Trisomy 21 and NF1 is essential for a reliable and predictable outcome. However, as neurofibromas are often known to recur, the treatment risks and advantages should be reviewed prior to surgical intervention.

Native American patients had a highly significant predisposition to violence and road traffic accidents resulting in maxillofacial fractures and CHIs. The high blood alcohol levels found in this group also reflected longstanding serious sociologic problems. This study provides a useful model to investigate the relative ethnic/racial role of comminuted paranasal structures for the protection of the brain (i.e., the crumple zone).