case_images: PMC10546930_01
case_images: MRI images after admission (A-F): (A) MRI with T2 sequences, (B) MRI with diffusion sequences, (C-F) T1 axial sequence with gadolinium, showing multiple intracranial abnormalities were enhanced, meningitis was considered, and brain abscess in the left temporal lobe was formed, bilateral frontal and left temporo-occipital regions were filled with pus under the skull inner plate and the dura mater of the longitudinal fissure pool, and multiple swelling of the left temporal region.
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case_images: MRI showed that multiple intracranial abnormalities were enhanced, meningitis was considered, and brain abscess in the left temporal lobe was formed, bilateral frontal and left temporo-occipital regions were filled with pus under the skull inner plate and the dura mater of the longitudinal fissure pool, multiple swelling of the left temporal region, facial region, internal pterygoid muscle and external pterygoid muscle was considered, inflammatory lesions were considered, and left middle ear mastoiditis (Figure 1).
case_images: CT examination on the fifth day after admission.
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case_images: CT examination showed that the left frontotemporal crest, right frontal part, and left subdural low density shadow of the longitudinal fissure pool were significantly larger than before, and cerebral hernia was formed (Figure 2).
case_images: Images of intraoperation: (A) pus collected during surgery, (B) pus discharged after craniotomy, (C) pus after opening the dura.
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case_images: The images of intraoperation were as shown in Figure 3.
case_images: The Third Next Generation Sequencing and Gene Diagnosis.
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case_images: TNGS & GD results of the left facial abscess and intraoperative pus showed the total length of the Porphyromonas gingivalis covering the genome was 2933 bp, the coverage was 3.21% (Figure 4), while the result of bacterial culture was nothing. The patient was diagnosed with Porphyromonas gingivalis, and treated with meropenem and metronidazole.
case_images: The CT of the second day after operation. Diagnosis (TNGS & GD) result of the patient.
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case_images: On the second day after operation, the CT scan of the skull showed that the arc density shadow under the skull inner plate of the left frontotemporal part disappeared, the compression of the adjacent sulcus and gyrus was slightly reduced, and the structure is centered (Figure 5).