title: Fatal thalamic abscess secondary to dental infection.
abstract: We present the case of poor neurological recovery and subsequent death secondary to a thalamic abscess in a 53-year-old man. This patient initially presented with sudden dysarthria and left hemiparesis while driving. Neuroimaging showed a multilobular abscess involving the right thalamus with oedema extending to the basal ganglionic region and brainstem. The source of the abscess was initially unknown and it required draining multiple times while the different causes were being explored. The patient's neurological state along with intubation made for a difficult and inconclusive oral examination. It was only after neuroimaging included tooth-bearing areas that it became evident that this patient had extensive periodontal disease with multiple areas of periapical radiolucencies. The patient underwent complete dental clearance alongside repeated drainage of the abscess. Despite initial postoperative improvement, the patient never recovered from the neurological damage and died 3 weeks later.
authors.affiliation: Department of Maxillofacial Surgery, Addenbrooke's Hospital, Cambridge, UK University of Cambridge, Cambridge, UK.
authors.forename: Shadi
authors.identifier: http://orcid.org/0000-0003-0172-824X
authors.initials: S
authors.lastname: Basyuni
authors.affiliation: Department of Maxillofacial Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Valmiki
authors.identifier: http://orcid.org/0000-0003-2259-6792
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Maxillofacial Surgery, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Vijay
authors.identifier: http://orcid.org/0000-0003-2574-8413
authors.initials: V
authors.lastname: Santhanam
authors.affiliation: Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Ashley
authors.initials: A
authors.lastname: Ferro
mesh_terms: D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004322:Drainage; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000382:microbiology / Q000601:surgery; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D034367:Streptococcus intermedius / Q000302:isolation & purification*; D013788:Thalamus / Q000382:microbiology* / Q000473:pathology