11.1 Headache attributed to disorder of cranial bone

Identification: A 68-year-old male patient with a history of chronic sinusitis reports a progressive frontal headache for 3 weeks. History of Present Illness: Pain: Location: Bilateral frontal, fixed Characteristic: Deep, continuous, pressure-like (intensity 6-8/10) Aggravating factors: Percussion of the frontal bone and prone position Associated symptoms: Palpable edema in the frontal region (Pott's puffy tumor) Evening fever (37.8-38.2°C) Intermittent purulent nasal discharge Relevant history: Frontal sinus surgery 2 years ago Physical and Neurological Examination: Inspection: Frontal swelling with local erythema Cutaneous fistula with purulent drainage (2mm) Palpation: Pain on digital pressure of the frontal bone Irregular bone growth Neurological: No focal deficits Isocoric pupils and normal reflexes Complementary Exams: Cranial Computed Tomography: Irregular thickening of the inner table of the frontal bone (8mm) 1.5cm bone sequestration Associated frontal sinusitis Magnetic Resonance Imaging (with contrast): Localized meningeal enhancement adjacent to the lesion 5mm epidural abscess Laboratory: Leukocytosis (14,000/mm³) with left shift CRP: 48mg/L Exudate culture: Methicillin-resistant Staphylococcus aureus (MRSA)