Brain abscess (BA) is a life-threatening condition with a high mortality rate. With the advancements in neurosurgical procedures, the mortality of BA has decreased in recent years. However, it remains unchanged in developing countries. Most population in Southeast Asia does not have proper access to neurosurgical care resulting in neglection and treatment delay. The most common predisposition related to delay in BA is chronic suppurative otitis media (CSOM). The infection spreads and usually resulting singular abscess formation that mostly located in the temporal lobe or cerebellum. However, in a very rare case, a longterm neglection may lead to multiple BAs formation.

In our case, a female infant had a history of pus discharging from the left ear at her 22-days-old. The patient was taken to a traditional healer, then the ear was routinely blown twice a week.

No improvement was found for 2 months treatment. The patient than was brought to a rural hospital and was treated with 2 types of antibiotics for 1 week admitting. No laboratory or imaging examinations were performed due to limited equipment. 1 week after being outpatient, the pus reoccurred, but no medical treatment was given to the patient. Since then, the patient experienced progressive increase of head circumference. At her 4-monthsold the patient had a history of continuous high fever followed by 3 episodes of generalized-tonicclonic convulsion, then was referred to our hospital. A head computed tomography showed multiple rim-enhancing lesions, ventricles dilatation and absence of left mastoid air cells. Burr hole aspiration was done in Emergency Room and laboratory blood tests were performed. However, tests showed negative results.

The formation of multiple BAs caused by CSOM could happen in a very rare case due to neglection. In order to decreasing the mortality and morbidity, Indonesian Neurosurgical Society intensively conducts training through Primary Neuroemergency and Neurosurgical Life Support (PNNLS) to provide proper neurosurgical service in rural or remote areas in Indonesia. Keywords Multiple BAs, neglection CSOM

Arie Ibrahim, MD. PhD. is formerly Head of Neurosurgery Department of Abdul Wahab Sjahranie Hospital / Medical School of Mulawarman University. Arie Ibrahim, MD. PhD was Head of Mulawarman Research Laboratorium Medical School and currently works as a researcher and lecturer in Medical School of Gadjah Mada University, Yogyakarta-Indonesia