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At least 199 records · Page 11Linked to original sources
PubMed1986

Nonsurgical treatment of a traumatic brain abscess in a child.

A large traumatic brain abscess in a 9-year-old white boy was successfully treated conservatively with antibiotics, including metronidazole and ampicillin. No neurological or psychological sequelae, except for unilateral loss of the olfactory sense, were revealed at follow-up 5 years later, and on CT two minor hypodense areas remained in the right frontal lobe. Our treatment protocol includes metronidazole (0.5 g 3 times a day) and ampicillin (1 g 6 times a day) for adults. This seems to be the treatment of choice in cases of intracranial brain abscesses.

Ampicillin↗
PubMedDate not supplied

Neonatal bacterial meningitis complicated with multiple brain abscesses and intraventricular rupture: report of one case.

Brain abscess is rarely encountered in neonates and carries a high morbidity and mortality. Here we report a premature infant who developed systemic Escherichia coli (E. coli) infection resulting in multiple brain abscesses with intraventricular rupture at 3 months postnatal age. He was treated successfully with a combination of surgical and antimicrobial therapies. Related literature on brain abscess with special emphasis on intraventricular rupture is reviewed.

Brain Abscess↗
PubMed2003

Multiple brain abscesses caused by Fusobacterium nucleatum treated conservatively.

BACKGROUND: Multiple brain abscesses are serious neurological problems with high mortality and disabling morbidity. The frequency is rising as a result of AIDS and the increasing number of immunocompromised patients. CASE STUDY: A 59-year-old woman developed signs and symptoms of diffuse brain dysfunction including fever and neck stiffness. A brain CT scan demonstrated nine contrast-enhancing ring-shaped lesions. Analysis of the cerebrospinal fluid using PCR-technique revealed DNA of Fusobacterium nucleatum. Conservative treatment with antibiotics was successful. The patient recovered with only mild cognitive deficits. RESULTS: The experience of our patient and the review of the literature indicate that multiple brain abscesses due to Fusobacterium nucleatum are rare. The most probable source is oral infection. CONCLUSION: Multiple brain abscesses may be caused by Fusobacterium nucleatum. Cerebrospinal fluid analysis using PCR technique is helpful with diagnosis. Conservative management can be successful.

Anti-Bacterial Agents↗
PubMed1995

Brain abscess in children: microbiology and management.

Brain abscess is a serious, life-threatening infection. The infection can originate from contiguous sites of existing infections, such as chronic otitis media, dental infection, mastoiditis, or sinusitis, where anaerobic bacteria predominate. The infection can also occur in children with cyanotic congenital heart disease, in whom the predominant organisms are viridans, microaerophilic, or anaerobic streptococci, or after head trauma, in which case Staphylococcus aureus, viridans cocci, and Streptococcus pneumoniae are the most prevalent isolates. Enterobacteriaceae, Pseudomonas aeruginosa, yeast, fungi, and mycobacteria are prevalent in the immunocompromised. Radioisotope brain scans, computed tomography, and magnetic resonance imaging are important tools that enable accurate diagnosis of the infection. Proper selection of antimicrobial with good intracranial penetration is essential in the management of intracranial infection. Delay in surgical drainage can be associated with high mortality or morbidity. However, brain abscess, especially in the early phase of cerebritis, may respond to antimicrobial therapy without surgical drainage.

Anti-Bacterial Agents↗
PubMed1997

[Fatal brain stem infarction due to rupture of a brain abscess: a case report].

We report a case of a brain abscess which initially presented with subcortical hematoma and ultimately resulted in fatal brain stem infarction due to its rupture into the subarachnoid space. A 50-year-old male was admitted to a nearby hospital with complaints of headache, fever, and sensory aphasia. He had ventricular septal defect found 15 years previously, sinusitis, and liver cirrhosis. Computerized tomographic (CT) scan revealed a left temporal subcortical hematoma. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) showed faint ring-like enhancement at the margin of the lesion. The left internal carotid angiogram demonstrated the vascular blush and early venous filling of the vein of Labbé. Administration of antibiotics and predonine resulted in resolution of fever within five days. MRI obtained 17 days after the onset showed typical ring-like enhancement. The mass was just adjacent to the lateral ventricle. The patient was transferred to our hospital for further examination and treatment 21 days after the onset. Fever had recurred 2 days before admission to our hospital. One day after admission, the patient began to vomit. About 15 hours following this symptom, he suddenly became comatose and tetraplegic. CT scan demonstrated a rupture of the abscess. Emergent drainage from the lateral ventricle and the abscess cavity was undertaken. Follow-up CT scan revealed multiple infarctions involving the upper brain stem and the bilateral thalamus. He died on the 29th day after the onset. The mechanisms of hemorrhage with a brain abscess and cerebral infarction after rupture of brain abscess are discussed. Hemorrhage with brain abscess is extremely rare. However, brain abscess should be considered as a possible etiology of an atypical hematoma. To avoid fatal rupture of the brain abscess, immediate treatment is essential. Once the rupture of the brain abscess occurs, its contents might cause vasospasm severe enough to cause cerebral infarction.

Brain Abscess↗
PubMed1999

[Diagnosis and treatment of brain abscesses].

The etiologic pathogens of brain abscesses vary depending on the underlying disease. Aerobic and anaerobic bacteria are frequently involved simultaneously. In most cases, the clinical course is subacute. C-reactive protein is the most sensitive inflammatory parameter in the blood. It is elevated in 80 to 90% of all cases. The diagnosis is made by cranial computer tomography without and with contrast enhancement. The rapid culture of pus from the abscess cavity is crucial for the identification of the pathogen. Antibiotic therapy alone is indicated 1. in the presence of multiple, small and/or deep-seated abscesses or 2. when the general condition of the patient does not allow surgery at an acceptable risk or 3. in early cerebritis without capsule formation. Frequently used surgical procedures are abscess aspiration (usually by stereotaxic surgery), open craniotomy and excision of the abscess with the capsule, and open evacuation of the abscess cavity. For empirical treatment the combination of cefotaxime (3 x 2-4 g/d i.v.) plus metronidazol (3-4 x 0.5 g/d i.v.) is preferred. Corticosteroids are indicated in the presence of a space-occupying effect and imminent brain herniation, or of multiple abscesses and abscesses in critical brain regions such as in the cerebellum.

Anti-Bacterial Agents↗
PubMed1986

A model of brain abscess: septic homologous blood clot emboli in rats.

Brain abscesses in rats were produced by intra-arterial injection of septic homologous blood clot emboli. The production rate was 100% and the histopathological features closely resembled those seen in other animal models and in spontaneously occurring brain abscesses in humans. This small-animal model may be useful for systematic study of the development of brain abscesses as well as for evaluation of various therapeutic procedures.

Abscess↗
PubMed1994

Brain abscess following marrow transplantation: experience at the Fred Hutchinson Cancer Research Center, 1984-1992.

The etiology of brain abscess in patients undergoing marrow transplantation at the Fred Hutchinson Cancer Research Center in Seattle was assessed in a retrospective review. Fifty-eight patients with histology- or culture-proven brain abscess diagnosed between January 1984 and March 1992 were identified. A fungus was isolated in 92% of cases. Aspergillus species were the most prevalent fungi (58% of cases), and Candida species were second in frequency (33%); sporadic cases were caused by Rhizopus, Absidia, Scopulariopsis, and Pseudallescheria species. Bacteria were involved in fewer than 10% of cases. There was no appreciable variation from year to year in the incidence of brain abscess over this period. Aspergillus brain abscess was associated with concomitant pulmonary disease (87% of cases), whereas candida brain abscess often occurred in association with fungemia (63% of cases) or neutropenia (63%). Mortality was high (97%); the risk of death was unrelated to etiology or therapeutic regimen. Since the etiology of brain abscess in patients undergoing marrow transplantation is primarily fungal, the development of better antifungal therapeutic and/or prophylactic modalities is warranted.

Adolescent↗
PubMed2001

[Multiple brain abscesses associated with Rendu-Osler-Weber disease: report of two cases].

Two cases of multiple brain abscesses associated with congenital pulmonary arteriovenous fistula are reported. A 57-year-old male with Rendu-Osler-Weber disease complicated by pulmonary arteriovenous fistula developed multiple brain abscesses in the right parietal region. He responded well to surgical drainage and antibiotic therapy, and the pulmonary arteriovenous fistula, located in the left lower lobe, was resected. A 26-year-old female with Rendu-Osler-Weber disease complicated by pulmonary arterivenous fistula developed recurrent multiple brain abscesses in both the frontal and right parietal regions. The brain abscesses were successfully treated with aspiration and antibiotic therapy. She had a history of two previous brain abscesses in the right parietal regions that were excised on separate occasions at 16 and 23 years of age. Although pulmonary arteriovenous fistula was confirmed by angiography, in this case surgical removal of the pulmonary lesions was not indicated due to multiple vascular shunting. The patient had no recurrence of brain abscess with oral antibiotic therapy.

Adult↗
PubMed1990

[Non-operation management of 12 cases with brain abscess demonstrated by CT scan].

This paper reported 12 cases with brain abscess demonstrated by CT scan. Using antibiotic management without surgical intervention, in 10 cases the curative effects were satisfactory. The paper indicated that CT scan was very useful in prompt and correct diagnosis of brain abscess and with sequential CT scan medical therapy was feasible. It is significant in treatment of brain abscess especially for the patients who have a poor general condition, have the brain abscess located in important functional area or have multiple abscesses so that the operation is difficult for them.

Adolescent↗
PubMed1994

Nocardial brain abscess: treatment strategies and factors influencing outcome.

The successful management of nocardial brain abscess remains problematic. The authors report 11 cases of nocardial brain abscess treated between 1971 and 1993 and review 120 cases reported since 1950. The clinical findings included focal deficits in 55 patients (42%), nonfocal findings in 36 (27%), and seizures in 39 (30%). Extraneural nocardiae were present in 66% of the cases; pulmonary (38%) and cutaneous/subcutaneous (20%) locations were the most frequent. The abscesses were single in 54% of the patients, multiple in 38%, and of unknown number in 8%. Forty-four of 131 patients (34%) were immunocompromised; since 1975, 18 of 40 immunocompromised patients (45%) were transplant recipients and six (15%) had human immunodeficiency virus. The mortality rate was 24% after initial craniotomy and excision (11/45), 50% after aspiration/drainage (17/34), and 30% after nonoperative therapy (7/23); 29 cases (22%) were diagnosed at autopsy. The mortality rate was 33% in patients with single abscesses and 66% in those with multiple abscesses (P < 0.0003). There was no difference in the mortality rates of immunocompromised and nonimmunocompromised patients treated before computed tomography (CT) was available; since the advent of CT, however, the mortality rate has been significantly higher in immunocompromised patients (55% vs. 20%, P < 0.05). Although the mortality rate for nocardial brain abscesses has dropped almost 50% since the advent of CT, it has remained virtually unchanged in immunocompromised patients and is three times higher than that of other bacterial brain abscesses (30% vs. 10%). The authors recommend image-directed stereotactic aspiration for diagnosis; however, craniotomy and total excision are necessary in most cases, because nocardial abscesses are usually multiloculated. Patients with minimal neurological deficits or small abscesses may be treated initially with antibiotics alone. Sulfonamides, alone or in combination with trimethoprim, are most effective and should be continued for at least 1 year. Minocycline, imipenem, or aminoglycoside in combination with a third-generation cephalosporin may be used with reasonably good success as second-line agents in cases of allergy or nonresponsiveness to sulfa agents.

AIDS-Related Opportunistic Infections↗
PubMed1989

Treatment of experimental brain abscess. 2. Effects of combinations of hyaluronidase with antibiotics and dexamethasone.

Brain abscess formation was studied experimentally in rats to determine the most appropriate nonsurgical treatment method by applying different combinations of hyaluronidase, dexamethasone and antibiotic sensitive to the inoculated bacteria in various stages of classical abscess development. The results showed that combined therapy with antibiotic and hyaluronidase started the day before inoculation averted the formation of brain abscess and the same therapy started after encapsulation, effectively eliminated the organisms and resolved the infection leaving a glial scar. But the same therapy, only started at the cerebritis stages, caused an increase of cerebritis. The addition of dexamethasone reduced the oedema but enhanced the cerebritis and delayed encapsulation. Though neurosurgical intervention continues to be the definitive method for eradicating the infection and preventing the pressure-related complications of brain abscess, our concept of management with hyaluronidase and appropriate antibiotic might be a new effective chemotherapeutic method of encapsulated brain abscesses in selected high-risk patients.

Animals↗