{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T11:10:09Z","timestamp":1745752209146,"version":"3.40.4"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,11]]},"abstract":"<jats:p>A 60-year-old male patient with a large infected cranial apex lesion was admitted with lethargy and mental status changes. The patient underwent evaluation with imaging studies, a skin biopsy, cultures with microscopy and a diagnostic burr hole. MRI and positron emission tomography\/CT scan revealed a squamous cell carcinoma with ingrowth in the midline of the brain and subdural empyema infected with<jats:italic>Streptococcus anginosus<\/jats:italic>and<jats:italic>Staphylococcus aureus<\/jats:italic>.<\/jats:p><jats:p>High dose intravenous antibiotic treatment was initiated and the patient subsequently underwent a surgical resection of the carcinoma with a 1\u2009cm margin of surrounding skin and skull. The defect was reconstructed using a titanium plate and a free microvascular lattisimus dorsi muscle flap then covered with a split skin graft.<\/jats:p><jats:p>The patient received 37 radiation therapy sessions (66 GY) as adjuvant therapy.<\/jats:p><jats:p>Intensive neurorehabilitation slowly improved an initial paraparesis. The 7-month follow-up revealed a satisfactory cosmetic result and residual gait impairment secondary to central nervous system invasion.<\/jats:p>","DOI":"10.1136\/bcr-2017-222271","type":"journal-article","created":{"date-parts":[[2018,4,28]],"date-time":"2018-04-28T16:10:17Z","timestamp":1524931817000},"page":"bcr-2017-222271","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment and reconstruction of a complicated infected scalp squamous cell carcinoma with CNS invasion"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3339-6120","authenticated-orcid":false,"given":"Andreas N\u00f8rgaard","family":"Glud","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frantz Rom","family":"Poulsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Linnet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Ahm","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,4,28]]},"reference":[{"key":"2025042703305031000_2018.apr28_1.bcr-2017-222271.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2012.11.037"},{"key":"2025042703305031000_2018.apr28_1.bcr-2017-222271.2","doi-asserted-by":"crossref","first-page":"538","DOI":"10.5999\/aps.2016.43.6.538","article-title":"The relationship between the size and the invasion depth of tumors in head and neck cutaneous squamous cell carcinoma","volume":"43","author":"Lee","year":"2016","journal-title":"Arch Plast Surg"},{"key":"2025042703305031000_2018.apr28_1.bcr-2017-222271.3","first-page":"CD011161","article-title":"Sun protection for preventing basal cell and squamous cell skin cancers","volume":"7","author":"S\u00e1nchez","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025042703305031000_2018.apr28_1.bcr-2017-222271.4","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1002\/hed.24512","article-title":"AHNS series - Do you know your guidelines? 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