Neurotoxic Effects Of Ammonia In A Patient With Ornithine Transcarbamylase Deficiency And Bilateral Brain Abscesses: Case Report

Brain abscesses are a rare complication of dental procedures. High concentrations of ammonia in brain abscesses may increase vasogenic edema and other brain abscess symptoms. Ornithine transcarbamylase deficiency (OTCD) is an x-linked genetic disorder of the urea cycle associated with an increased risk of brain damage due to hyperammonia. During acute metabolic decompensations, due to stresses such as infection in OTCD patients, blood ammonia levels become moderately high. This, in turn, causes cerebral glutamine levels to increase and exacerbate cerebral edema and neurological symptoms. In this report, we present a 25-year-old woman with known partial OTCD who presented with bilateral brain abscesses 2 weeks after a wisdom tooth extraction. Neurotoxic effects of ammonia, from local ammonia formation in brain abscesses positive for streptococcus intermedius, or due to her OTCD, may have exacerbated the cerebral edema, which resulted in irreversible encephalopathy that lead to her death.