Man with a seizure.

PATIENT PRESENTATION

A 31‐year‐old male with a history of traumatic brain injury with seizure disorder presented to the emergency department (ED) via emergency medical services (EMS) after a motor vehicle collision. On EMS arrival, the patient was having seizure‐like activity. On arrival to the ED, the patient had a Glasgow Coma Scale score of 15 with a complaint of a mild headache.

Non‐contrast head computed tomography revealed areas of encephalomalacia with extensive right temporal craniectomy postoperative change, sinonasal surgery, and cranialization of the frontal sinus with a hyperdense process in the right anterior frontal region (Figures 1 and 2). Given the seizure and hyperdense process, magnetic resonance imaging was ordered. It revealed a right frontal lobe fluid collection, 3 × 3 × 2 cm, that appeared to extend from right frontal sinus concerning for Pott's puffy tumor versus mucocele (Figures 3 and 4).

FIGURE 1

Axial view of initial non‐contrast head computed tomography showing hyperdense collection (thin arrows) and cranialization of frontal sinus (thick arrows)

FIGURE 2

Coronal computed tomography showing hyperdense fluid collection and encephalomalacia

FIGURE 3

Coronal T1 magnetic resonance imaging redemonstrating hyperdense fluid collection and encephalomalacia seen on computed tomography

FIGURE 4

Axial magnetic resonance imaging flair redemonstrating the hyperdense fluid collection seen on computed tomography (ruler)

Patient was admitted, a bifrontal craniotomy was performed, the mass was removed, and a diagnosis of mucocele was made.

DIAGNOSIS

Mucocele

Mucoceles are benign slow‐growing lesions that consist of respiratory epithelium filled with mucoid secretions. A total of 60%–89% occur in the frontal sinus and usually present in the fourth through sixth decade of life. Mucoceles are often associated with chronic rhinosinusitis; however, trauma can be a precipitating event. In rare cases, the mucocele can erode through a sinus into the intracranial space leading to significant neurological events, such as meningitis, abscess, and seizures, as in this case. It is important for emergency medicine physicians to keep this on the differential for recurrent seizures in adults.