Pott puffy tumor is a rare clinical entity. Sir Percival Pott, a British surgeon, was the first to describe it in 1768, as a complication of cranial trauma. Later, a clear relationship was observed between this lesion and untreated frontal sinusitis. It has also been reported after mastoid surgery, dental infections and insect bites rarely [1]. The sinus of frontal begins to be aerated at the age of 6 and achieved its development at the age of 15, adolescents are more inclined to this lesion, but Pott puffy tumors can also be seen in younger age groups [2]. Intracranial complications represent around 60% and 85% of cases in adults and nearly 100% in children [3]. Subdural or epidural empyema, frontal brain abscesses, cavernous sinus thrombosis, but also cortical venous thrombosis, and acute meningitis can be described [4]. All these complications are most often secondary to frontal osteomyelitis.

The most common symptoms are fever, headache, swelling in the periorbital or scalp regions, and rhinorrhea, For some authors, an erythematous and frontal swelling or fluctuant swelling in the midline of the forehead associated with fever should be considered as pathognomonic of Pott puffy tumor [5]. In the present case, the patient presented in addition to headache and frontal swelling, signs of neurological disorders such as motor aphasia.

A positive diagnosis is made by imaging performed as an emergency because early diagnosis and treatment are vital for the prevention of intracranial complications. Cerebral CT with contrast injection is the exam of choice to obtain the diagnosis. It shows frontal sinusitis, osteomyelitis characterized by bone erosion, and subperiosteal abscesses and may be associated with intracranial extension, especially sub or extradural empyema and frontal abscesses that increase morbidity and mortality [6].

The most frequently incriminated germs are staphylococcus, streptococcus, and anaerobes, however anaerobic and microorganisms polymicrobial are dominant in intracranial complications [7]. In our case, no germs were identified. The therapeutic management of Pott's puffy tumor is based on the combination of antibiotic therapy and surgical treatment which would prevent possible complications. Antibiotic therapy should be started as soon as possible after the diagnosis is suspected, it is most often administered intravenously and it must be broad-spectrum, targeting the majority of germs, it is then adapted to the germ identified by bacteriological examination. The duration of this antibiotic therapy is 4 to 8 weeks due to the presence of osteomyelitis but also to complications. Parida et al reported that all patients underwent surgical intervention and that treatment with broad-spectrum antibiotics continued for 6–8 weeks [8]. The ideal combination would be based on penicillin or vancomycin, 3rd generation cephalosporins, and metronidazole. Surgical management is variable and may be limited to percutaneous drainage or trephination, a craniotomy may be necessary in case of serious intracranial complication to decrease morbidity and shorten hospital stay [9]. Pott's tumor is a complicated infection, usually seen in the setting of untreated or poorly treated sinusitis. serious entities can develop, including intracranial complications, which increase morbidity and mortality. This requires early surgical management and intravenous antibiotic therapy.