[The treatment of chronic brain abscesses and its results].
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Abscess↗
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Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) complicated by pulmonary arteriovenous fistula and brain abscess.
A man who developed two brain abscesses was later found to have hereditary hemorrhagic telangiectasia with a pulmonary arteriovenous fistula. Brain abscess is a known complication of pulmonary arteriovenous fistulas. About 15% of patients with hereditary hemorrhagic telangiectasia develop such a fistula during their lives. Surgical resection of pulmonary arteriovenous fistulas is recommended because of the risk of severe neurological sequelae.
Adult↗
[Calcified brain abscess: a case report].
Calcified brain abscesses are rare. A huge one is reported. A six years old feale had a fistula at the left frontal region for about three years. Patient was gored by a cow. Three years later Staphylococcus aureus was identified in the pus. The post operative neurological recovery was good.
Brain Abscess↗
[Pathogenesis and methods of treatment of otogenic brain abscess].
UNLABELLED: Otitis media, acute or chronic, is a potentially dangerous disease which may lead to fatal complications. Meningitis is the most common intracranial complication, followed by otogenic brain abscesses while lateral sinus thrombosis is fairly uncommon. Mortality from otogenic brain abscesses remains relatively high. The aim of the study was to investigate mechanisms of development, diagnostic methods and treatment of these complications of otogenic brain abscesses. MATERIAL AND METHODS: The retrospective study covered 42 patients with otogenic brain abscess (28 cerebral and 14 cerebellar) treated from 1973 to 1995 at the ENT and Neurosurgical Hospital in Belgrade. Medical records of the studied patients were analyzed for the occurrence of the disease, diagnosis and mode of therapy. Special care was dedicated to type of otitis, surgical findings, diagnostic methods, mode of therapy and therapy outcome. RESULTS: In the period of 23 (1973-1995) 114 patients with otogenic intracranial complications were treated at the Clinic of Otorhinolaryngology and Maxillofacial Surgery. Meningitis was the most common complication in this series, followed by cerebral abscess, lateral sinus thrombosis, cerebellar abscess, while extradural abscesses were rare, and subdural occurred only exceptionally (Table 1). In somewhat more than half of the patients (55%) one intracranial complication was present, While in 54% two or more intracranial complications were recorded (Table 2). Otogenic brain abscesses are usually associated with meningitis. Meningitis was present in 20 patients with cerebral abscess (71%), and in 5 (33%) patients with cerebellar abscess. Meningitis and lateral sinus thrombosis were more commonly associated with cerebellar abscess (41%), and less with cerebral abscess (10%). In our group of patients otogenic brain abscesses were most common in the third decade of life, than in the second, while the frequency of the complication fell significantly in older age groups (Figure 1). Headache (92%). fever (91%), vomiting (68%) were the most common symptoms, while photophobia and vertigo were less common (38% and 30%, respectively). Active chronic otitis with cholesteatoma was most commonly present in patients with otogenic brain abscess, only somewhat more common in patients with cerebral abscess (84%), than in those with cerebellar abscess (80%). Neurological examination of 28 patients with cerebral abscess evidenced the abscess in 11, while in 15 the examination suggested meningitis. (Table 3). The diagnosis of abscess was most commonly established by computerized tomography. It revealed cerebral abscess in 18 out of 28 patients, and cerebellar abscess in 10 out of 12 patients. (Table 3). Radical trepanation of the temporal bone was performed in all our patients, while in nine patients revision was required after the surgery, since the initial operation was not sufficiently radical. (Table 4). Out of 28 patients with cerebral abscess 5 (18%) died while 3 (29%) patients died out of 14 patients with cerebellar abscess (Table 4). DISCUSSION: Otogenic brain abscesses imply accumulation of pus in the cerebrum or cerebellum developing after encephalitis, caused by pyogenic microorganisms originating from inflammatory process in the middle ear cavity. This is a severe otogenic complication with high mortality. Even with modern therapeutic alternatives, mortality remained high, about 40% (7). According to the data reported by several authors introduction of antibiotic therapy resulted in drastic fall of associated mortality. The annual risk of otogenic abscess of the brain is 1 per 1000 adults with active chronic otitis. The incidence of abscess is significantly higher in a certain age groups, i.e. 1 per 200 between the ages of 20 and 40 (3). The diagnosis of brain abscess established clinically is not quite reliable. The disease is usually associated with severe meningitis, so that neurological examination usually detects only signs of meningi
Adult↗
[Comparative analysis of surgical methods in the treatment of brain abscesses].
A hundred and ten patients with brain abscesses have undergone surgical treatments: 8, 39, and 63 patients had aspiration, drainage, and removal of abscess with a capsule, respectively. Comparative analysis of surgical treatments revealed that removal of abscesses with a capsule was the most effective operation. Indications and contraindication to each surgical treatment of brain abscesses were defined.
Adolescent↗
Multiple pyogenic brain abscesses: an analysis of 21 patients.
Multiple pyogenic brain abscesses constituted 11.7% (21 patients) of a series of 179 consecutive patients with brain abscess treated from 1976 to 1984. The commonest cause of these abscesses was congenital cyanotic heart disease (38%), followed by middle ear infection (19%). Two thirds of these patients were in the first two decades of life. The clinical presentation was similar to brain abscesses in general, there being no clinical features suggestive of multiple lesions. In 85% the abscesses were supratentorial. Infratentorial abscesses alone or in association with supratentorial abscesses were invariably otogenic in origin. Aspiration of the largest abscesses supplemented with appropriate antibiotics was the treatment of choice in 16 patients; secondary excision of the largest abscesses was required in six patients. Primary excision was performed in three patients when the abscesses were in close proximity to each other. Two patients were managed with antibiotics alone. The overall mortality was 23.8%.
Adolescent↗
Childhood brain abscess in Saudi Arabia.
The characteristics of childhood brain abscess in Saudi Arabia are outlined in this review of 17 consecutive cases treated at King Khalid University Hospital (KKUH) between 1985 and 1994. The data on 20 consecutive adults with brain abscess treated at KKUH during the same period were also analysed. Compared with series from the West, the children were unusual because of the relatively low incidence of cardiogenic and anaerobic abscesses and the relatively high incidence of post-traumatic, infratentorial and staphylococcal abscesses and sterile cultures. Compared with cases of brain abscess in adults, the children showed a much lower incidence of idiopathic abscess, a higher incidence of infratentorial abscess and a much better outcome. Factors accounting for the zero mortality rate in these children are discussed.
Adolescent↗
Proteus mirabilis brain abscess in a neonate.
Occasionally a brain abscess has been observed in a neonate. This report presents a unique case of a septic infant who developed a proteus mirabilis brain abscess shortly after birth, which persisted undetected until 21/2 months of age.
Ampicillin↗
Brucellar brain abscess and bilateral arachnoid cysts, unilaterally complicated by subdural haematoma.
Arachnoid cysts are benign developmental cysts that occur along the cerebrospinal axis. Brucellar abscesses in the brain are relatively uncommon, with only a few cases reported in the literature. We report here a patient with a brucellar brain abscess and bilateral arachnoid cysts (one complicated with subdural haemorrhage), who was successfully managed with craniotomy and antibiotics.
Aged↗
Treatment of bacterial brain abscess by repeated aspiration--follow up by serial computed tomography.
Bacterial brain abscess often requires repeated aspiration before the abscess finally resolves. However, there are no guidelines for treatment by aspiration; for example, when should the abscess be tapped again, or when can an abscess be treated by antibiotics alone without further aspiration. Eleven patients with bacterial brain abscess treated by aspiration were evaluated to establish treatment guidelines for brain abscess, in particular the abscess size on serial computed tomography (CT) after aspiration. CT was performed about 24 hours after aspiration to evaluate the size of the abscess, and almost weekly during follow up. The diameter of the brain abscess before and after the initial and last aspirations were reviewed. In eight of the 11 patients, abscesses were aspirated repeatedly: two to three times in most patients. The diameter of the abscesses was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean 2.3 cm) after the last aspiration, or when continuous drainage was discontinued. Perifocal edema was moderately decreased within 3 weeks after the last aspiration by medical treatment alone, with a concomitant decrease in the volume of the abscess. There were no deaths, and most patients had a favorable outcome. These results suggest that after the diameter of the abscess becomes less than 2 to 3 cm and does not increase anymore on serial CT, medical treatment alone can be anticipated to give satisfactory results without further aspiration.
Adolescent↗
Brain abscess associated with congenital pulmonary arteriovenous fistula.
A case of brain abscess associated with congenital pulmonary arteriovenous fistula was presented and 52 reported cases were reviewed. The brain abscess was successfully treated with repeated aspiration and drainage, and the pulmonary arteriovenous fistula, located in the right lower lobe, was resected. The arteriovenous fistula occurs as a common pulmonary manifestation of hereditary hemorrhagic telangiectasia; however, no symptoms suggesting these two were noted in this case. Brain abscesses can be an initial clinical manifestation in asymptomatic pulmonary arteriovenous fistula. This possible association should be borne in mind in cases of brain abscesses of unexplained etiology.
Arteriovenous Fistula↗
PET findings in a brain abscess associated with a silent atrial septal defect.
Brain abscesses are classical complications of congenital heart disease (CHD) in children and adolescents. This association is rarely observed in adults. We report a 46-year-old man presenting a fronto-parietal abscess associated with an asymptomatic atrial septal defect. Positron emission tomography (PET) study revealed high uptake of L-[methyl-11C]methionine ([11C]methionine) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) around the brain abscess. We suggest (1) to exclude a silent cardiac malformation in the presence of a cerebral abscess of unknown source occurring in adults; (2) to consider the diagnosis of brain abscess in cases of high uptake of [11C]methionine and FDG in relation to a brain lesion.
Biopsy↗
Brain abscess secondary to otitis media.
Otogenic brain abscess still occurs despite advances in antibiotics. The possible diagnosis should be disproved rather than ignored in any patient who presents with a discharging ear and who has any intracranial symptoms. Otogenic brain abscess carries a 47.2 per cent risk of a fatal outcome and those patients who survive have a 95 per cent risk of developing epilepsy.
Adolescent↗
[EEG topographic changes of brain abscesses in children].
EEG topography was investigated before and after surgical treatment in 4 patients with brain abscess aged from 5 to 13 years. According to the recording technique designed by Matsuoka and Ueno, the recorded EEG for each 5 seconds was analyzed to obtain square roots of power spectra for each band of delta (2-3.8 Hz), theta (4-7.8 Hz) and alpha (8-12.8 Hz) which were then added for the 60-seconds duration of each trial. After that, numerical matrix presenting the topographic distribution of spectral energy of each band were constructed and displayed as color images. In addition, the EEG topographies of brain abscesses were compared with the CT scans simultaneously obtained. In all of four cases before surgical treatment of the brain abscess, the location of the focal delta wave on the EEG topography was more closely related to the site of brain abscess comparing with its correlation between the location of the delta focus on the conventional EEG and the site of brain abscess. In contrast, as for the theta wave, there was no prominent correlation to the site of the brain abscess. In the early stage of 10-15 days after aspiration of the brain abscess, the most characteristic change of the EEG topography was an approximately 25% reduction of the maximum equivalent voltage of delta band with associated disappearance of the sharply located focal delta wave being noted before aspiration.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Value of "low-signal zone" sign in the diagnosis of brain abscess in the capsule period].
OBJECTIVE: To evaluate the value of "low-signal zone" sign in the diagnosis of brain abscess in the capsule period. METHODS: The conventional MRI was performed pre-therapy in 21 patients with brain abscess in the capsule period and 25 patients with vesica-astrocytomas. We analyzed the pathologic basis of "low-signal zone" sign in brain abscess and compared the frequency and shape of "low-signal zone" sign in brain abscess and vesica-astrocytomas. RESULTS: The "low-signal zone" sign in MRI occurred more frequently in brain abscess (85.7%, 18/21) than in vesica-astrocytomas (52.0%, 13/25). The "low-signal zone" sign in the former was intact, while that in the latter was not. CONCLUSION: The "low-signal zone" sign is helpful to diagnose brain abscess in the capsule period, and is valuable to differentiate brain abscess and vesica-astrocytomas.
Adolescent↗
Staphylococcus cohnii as a cause of multiple brain abscesses in Weber-Christian disease.
We report a patient with multiple brain abscesses due to Staphylococcus cohnii. While these brain abscesses markedly responded to the antibiotics, this patient was subsequently suffered from subcutaneous inflammatory nodules in the adipose tissue, which diagnosed him as having Weber-Christian disease (WCD). This is the first report that subcutaneous inflammatory nodules in the adipose tissue, which lead the diagnosis of WCD, followed multiple brain abscesses. To our knowledge, S. cohnii has not yet been reported to cause multiple brain abscesses in humans. Although the etiology of WCD is unknown, an immune mechanism has been implicated in the pathogenesis. Therefore, we should notice that patients with WCD could be immunocompromised hosts with a higher risk to suffer from severe opportunistic infections.
Adipose Tissue↗
Multiloculated pyogenic brain abscess: experience in 25 patients.
OBJECTIVE: To report our experience in treating multiloculated pyogenic brain abscess and determine whether there are differences in the bacteriology, predisposing factors, treatment choices, and outcomes between multiloculated and uniloculated brain abscesses. METHODS: We studied clinical data collected during a 16-year period from 124 patients with pyogenic brain abscess, including 25 cases of multiloculated abscess. RESULTS: The incidence of multiloculated brain abscess was 20%. In these 25 patients, hematogenous spread from a remote infectious focus was the most common cause of infection, as it was for the cases of uniloculated abscess. Headache and hemiparesis were the most common symptoms in patients with multiloculated abscess. In patients with uniloculated abscess, fever was the most common symptom. Viridans streptococci were the most commonly isolated pathogens. Bacteroides fragilis was the most common anaerobe in multiloculated abscess, and aerobic gram-negative bacilli were the most common pathogens in patients with uniloculated abscess. Of the patients with multiloculated abscess, 21 were treated surgically and 4 were treated with antibiotics only. Overall, eight patients (38%) needed another operation because of abscess recurrence after the initial operation. In uniloculated abscess, the rate of abscess recurrence after initial surgery was 13.1%. Mortality was 16% in multiloculated abscess and 17.1% in uniloculated abscess. CONCLUSION: Multiloculated abscesses accounted for 20% of our patients with pyogenic brain abscess. Excision seems to be the more appropriate surgical choice in multiloculated abscess. Prognosis for patients with multiloculated abscess can be as good as that for patients with uniloculated abscess. However, clinicians must carefully monitor these patients because the possibility of recurrence after surgery is significantly higher in patients with multiloculated abscess than in those with uniloculated abscess.
Adolescent↗
[Nocardial brain abscess: surgery and postoperative antibiotic therapy].
Nocardial infections in an immunocompromised host have been increasingly reported. Nocardial brain abscess, the most common presentation of nocardiosis in the central nervous system, is associated with a high mortality rate because of its delayed diagnosis and its unresponsiveness to the usual antibiotic therapy. We report four patients who experienced a long-term cure of nocardial brain abscess due to treatment by a combination of surgery and postoperative antibiotic therapy; 1 man and 3 women, ages ranging from 43 to 67 years old. Two patients were associated with systemic lupus erythematosus and two with autoimmune hemolytic anemia. Patients underwent surgical aspiration and drainage of brain abscess. Nocardia was identified from the aspirated specimen and postoperative antibiotic therapy for 5-6 weeks was performed using effective antibiotic agents; sulfamethoxazole/trimethoprim (ST), imipenem/cilastatin and minocycline (MINO) in Case 1, ST and MINO in Case 2, erythromycin in Case 3, and panipenem/betamipron and cefotaxime in Case 4. Case 3 and Case 4 with multilobulated brain abscess underwent total excision of the brain abscess. All patients showed successful cure of nocardial brain abscess with no recurrence for the period of 1-8 years. The combination of surgery and postoperative antibiotic therapy provides a good prognosis for nocardial brain abscess.
Adult↗