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PubMed2001

[Familial brain abscess as a complication of hereditary hemorrhagic telangiectasia].

The hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) is an inherited autosomal dominant disease with angiodysplasia of the skin, mucosa, parenchymal organs, and it can affect the central nervous system. In 40% of the cases neurological complications, most frequently intracerebral abscesses occur. In this study, the case history of a patient with central nervous system manifestation of hereditary hemorrhagic telangiectasia showing familiar aggregation of brain abscess will be presented. A young male patient was admitted to Neurological Department because of his first epileptic seizure and progressive right hemispheric symptoms. His examinations showed frontal abscess, which was surgically removed. The frequent nose-bleeding of the patient and recurrent brain abscess in his brother's history provided the possibility of hereditary hemorrhagic telangiectasia. The background of brain abscess were multiple pulmonary arteriovenous malformation, which were embolized by repeated angiography. Familiar brain abscess is very rare. However, in the case of brain abscess especially with familiarity diagnosis of the Rendu-Osler-Weber disease should be considered.

Adult↗

PubMed1999

Role of diffusion-weighted echo-planar MRI in distinguishing between brain brain abscess and tumour: a preliminary report.

Our purpose was to evaluate diffusion-weighted (DW) echo-planar MRI in differentiating between brain abscess and tumour. We examined two patients with surgically confirmed pyogenic brain abscess and 18 with metastatic brain tumours or high-grade glioma, using a 1.5 T system. The apparent diffusion coefficient (ADC) of each necrotic or solid contrast-enhancing lesion was measured with two different b values (20 and 1200 s/mm2). All capsule-stage brain abscesses (4 lesions) and zones of cerebritis (2 lesions) were identified on high-b-value DWI as markedly high-signal areas of decreased ADC (range, 0.58-0.70 [(10-3 mm2/s; mean, 0.63)]). All cystic or necrotic portions of brain tumours (14 lesions) were identified on high-b-value DWI as low-signal areas of increased ADC (range, 2.20-3.20 [(10-3 mm2/s; mean, 2.70)]). Solid, contrast-enhancing portions of brain tumours (19 lesions) were identified on high-b-value DWI as high-signal areas of sightly decreased or increased ADC (range, 0.77-1.29 [(10-3 mm2/s; mean, 0.94)]). Our preliminary results indicate that DW echo-planar MRI be used for distinguishing between brain abscess and tumour.

Aged↗

PubMed2002

Thallium-201 accumulation in a patient with brain abscess.

A 57-year-old man was admitted to our hospital because of high fever and generalized tonic seizure. Brain magnetic resonance imaging (MRI) delineated multiple abnormal intensity areas. Thallium-201 (201Tl) scintigraphy revealed abnormal uptake in the brain. The imaging findings did not allow definitive exclusion of brain tumor, even though brain abscess was the more strongly suspected diagnosis. As the patient improved, the multiple abnormal intensity areas in the brain on MRI and the abnormal areas of accumulation on 201Tl scintigraphy were reduced, and eventually completely disappeared. A final diagnosis of brain abscess was therefore made. Since relatively few studies have reported 201Tl accumulation in cases of brain abscess, we report here our patient in whom the changes in the accumulation of 201Tl in a brain abscess were observed over time.

Brain Abscess↗

PubMed1985

[Role of computed tomographic control in brain abscesses and subdural empyemas].

The authors analysed their observation of 13 patients with brain abscesses and subdural empyemas which had been verified during operation or at autopsy. Brain abscesses and empyemas were caused by chronic inflammatory processes of otogenic or rhinogenic origin, traumas and surgical interventions as well as purulent inflammatory processes of other sites. Computerized tomography was shown to be a reliable method to diagnose brain abscesses and subdural empyemas. Owing to its high informative value CT made it possible to exactly define the stage of a purulent inflammatory process and to choose early and adequately a surgical method. CT is an indispensable means of postoperative control 4 weeks after operation in case of impairment of the patients' general status or in the absence of a therapeutic effect.

Adolescent↗

PubMed1995

Intraventricular rupture of a purulent brain abscess: case report.

The mortality of patients with brain abscesses has decreased significantly from 38% in the 1950s to 25% in the 1980s (P = 0.003, Fisher's exact test by decade of report; asymptotic P values based on chi 2 distribution with 3 degrees of freedom, 28 series, 2825 total patients). This decrease in mortality has been attributed to improved diagnostic imaging, the evolution of neurosurgical techniques and understanding of intracranial pressure pathophysiology, greater critical care understanding, and newer antibiotics. However, the mortality associated with the intraventricular rupture of brain abscesses (IVROBA) remained consistently high (at or above 80% once IVROBA was identified) throughout these decades. Although 129 cases (84.5% mortality, 20 survivors) of IVROBA were located in these series and an additional six case reports of survival after IVROBA were found in the literature, treatment advice and detailed clinical description of these surviving cases are sparse or absent. A case of IVROBA with good quality of survival is presented along with the aggressive five-component therapeutic plan used. The five components are: 1) open craniotomy with debridement of abscess cavity, 2) lavage of the ventricular system, 3) 6 weeks of intravenous antibiotics, 4) intraventricular gentamicin twice daily for 6 weeks, and 5) intraventricular drainage for 6 weeks.

Brain Abscess↗

PubMed1988

[A case of hemorrhage into a brain abscess].

A rare case of hemorrhage into a brain abscess in a 23-year-old man is reported. The patient complained of headache and low-grade fever on February 26, 1986. Two days later, he developed right hemiparesis and right hemisensory disturbance with mild consciousness disturbance and was admitted to a local hospital. Seven days after the onset, he suddenly became semicomatose, developed anisocoria and was consequently transferred to the University Hospital. On admission, his temperature was 37.5 degrees C and neurological examination revealed semicoma, anisocoria and right hemiparesis without nuchal rigidity. Enhanced CT scan showed a high density area within an irregular ring enhancement at the left basal ganglia. At that time, malignant glioma was diagnosed and an emergency operation was performed by left frontotemporal craniectomy. During the operation blood clot was found in the posterior part of the basal ganglia. After operation, a histological examination was made and a brain abscess was diagnosed. Gram staining revealed gram-positive bacillus. By aspiration of the abscess and chemotherapy, recovery was gradually made. He was discharged with motor dysphasia and mild right hemiparesis three months later. Differentiation between abscess and malignant glioma and the cause of the hemorrhage are discussed.

Adult↗

PubMed2006

Strategies for the management of bacterial brain abscess.

We reviewed the medical and surgical management of brain abscess and compared the results of different methods of treatment. Treatment of brain abscess requires a combination of antimicrobial agents, surgical intervention, and eradication of the primary foci of infection. We believe that pathologic confirmation and/or microbiologic studies are needed to ensure proper management, with the selection of antibiotics based on the available culture and susceptibility results. A 6- to 8-week course of parenteral antibiotics, plus regular follow-up computed tomography scans for at least 3 months to evaluate the therapeutic response is also recommended. The method of surgical treatment is of lesser importance than adherence to the basic principles of abscess management, and which surgical treatment is chosen depends on the patient's clinical status, the neuroradiographic characteristics of the abscess, and the experience of the surgeons who will be carrying out the procedure.

Anti-Bacterial Agents↗

PubMed2005

Brain abscess drainage by use of MR fluoroscopic guidance.

We describe herein the use of MR fluoroscopic guidance in the drainage of abscess cavities. We percutaneously drained 12 brain abscesses in 11 patients. A 0.3T open MR imaging system was used. Sixteen drainages were performed in 12 abscesses. Repeat drainage was needed in three recurrences and one residual lesion. No serious complications were seen. MR fluoroscopy-guided percutaneous brain abscess drainage in an open MR imaging system is feasible.

Adolescent↗

PubMed1988

Ipsilateral progressive hydrocephalus due to acquired foramen of Monro obstruction: an unusual complication of brain abscess in cyanotic heart disease. A case report.

An unusual complication of brain abscess in cyanotic heart disease is presented. This patient, who was suffering from recurring brain abscesses at different sites was diagnosed on regular follow-up, and a metrizamide computed tomographic ventriculogram confirmed the diagnosis of foramen of Monro obstruction ipsilateral to the abscess.

Brain Abscess↗

PubMed1990

[Diagnosis of brain abscess using computer tomography].

The author examined 29 patients with the diagnosis of brain abscess by computed tomography (CT). In 28 instances the CT finding visualized a hypodense formation with an annular colouration which became more marked after administration of the contrast substance. In one patient the abscess was a hyperdense homogeneous focus. The pathological formation always behaved expansively with the surrounding oedema. The CT findings were correlated with other examination techniques (electroencephalography, cerebral angiography, cerebral scintigraphy). Visualization of the brain abscess on CT is not specific for this diagnosis. The same picture may be caused by a brain metastasis, glioma, ischaemia, an absorbing haematoma. Substrate diagnosis is not possible without a detailed case-history, clinical examination, laboratory examination and other examination methods. After introduction of CT diagnosis the mortality of patients with brain abscesses declined markedly.

Adolescent↗

PubMed2004

Differentiation among metastatic brain tumors, radiation necroses, and brain abscesses using proton magnetic resonance spectroscopy.

Magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) were evaluated for differentiating metastatic brain tumors, radiation necroses, and brain abscesses. Twelve histologically verified lesions in 12 patients were studied using preoperative MRI and proton MRS. The signal intensities of four major metabolites, N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine and phosphocreatine (Cr), and lactate (Lac), were observed over the region of interest. Metastatic brain tumors showed a decrease in NAA/Cr and an increase in Cho/Cr ratios. Radiation necroses showed a decrease in NAA/Cr and no change in Cho/Cr ratios. Brain abscesses showed an increase in Lac/Cr ratio. Correlation with histopathologic findings showed that a high Cho signal was suggestive of a metastatic brain tumor. Lac signals were observed in brain abscesses, presumably reflecting the anerobic glycolysis of living cells. Although more cases and studies are necessary, metabolic information provided by proton MRS combined with MRI is useful for differentiating among metastatic brain tumors, radiation necroses, and brain abscesses.

Adult↗

PubMed1993

Spontaneous haemorrhage associated with a brain abscess.

Spontaneous haemorrhage in association with a brain abscess is a very rare occurrence and may confuse the CT diagnosis. A case of cerebral abscess with haemorrhage into the abscess cavity, the surrounding brain parenchyma, the subarachnoid space and the ventricular system is reported. The differential diagnosis, pathogenesis and the management of such a case are discussed and the literature reviewed.

Brain Abscess↗

PubMed2005

Toll-like receptor 2 modulates the proinflammatory milieu in Staphylococcus aureus-induced brain abscess.

Toll-like receptor 2 (TLR2) is a pattern recognition receptor (PRR) that plays an important role in innate immune recognition of conserved structural motifs on a wide array of pathogens, including Staphylococcus aureus. To ascertain the functional significance of TLR2 in the context of central nervous system (CNS) parenchymal infection, we evaluated the pathogenesis of S. aureus-induced experimental brain abscess in TLR2 knockout (KO) and wild-type (WT) mice. The expression of several proinflammatory mediators, including inducible nitric oxide synthase, tumor necrosis factor alpha, and macrophage inflammatory protein-2, was significantly attenuated in brain abscesses of TLR2 KO mice compared to WT mice during the acute phase of infection. Conversely, interleukin-17 (IL-17), a cytokine produced by activated and memory T cells, was significantly elevated in lesions of TLR2 KO mice, suggesting an association between innate and adaptive immunity in brain abscess. Despite these differences, brain abscess severity in TLR2 KO and WT animals was similar, with comparable mortality rates, bacterial titers, and blood-brain barrier permeability, implying a role for alternative PRRs. Expression of the phagocytic PRRs macrophage scavenger receptor type AI/AII and lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) was increased in brain abscesses of both TLR2 KO and WT mice compared to uninfected animals. However, LOX-1 induction in brain abscesses of TLR2 KO mice was significantly attenuated compared to WT animals, revealing that the TLR2-dependent signal(s) influence LOX-1 expression. Collectively, these findings reveal the complex nature of gram-positive bacterial recognition in the CNS which occurs, in part, through engagement of TLR2 and highlight the importance of receptor redundancy for S. aureus detection in the CNS.

Animals↗

PubMed1987

Ultrasound-guided brain abscess aspiration in neonates.

Four cases of brain abscess in neonates are described, diagnosed by ultrasonography and CT. All abscesses were confirmed surgically. One patient was operated on 5 weeks after diagnosis because of initial parental refusal. The etiology in all cases was meningitis superimposed on an hypoxic-ischemic insult. Two cases had a single abscess while the other two had multiple lesions. All cases were operated on with intraoperative ultrasound examination through the fontanelle. The case with delayed aspiration showed complete evolution from localized cerebritis to complete capsule formation with mass effect. One abscess was sterile, and in the others grew Klebsiella pneumoniae and Enterobacter aerogenes. The microorganism initially isolated from the lumbar CSF was also found in the abscess. Even after sterilization of the lumbar CSF, all abscesses were still present. Ultrasound examination and CT are compared.

Brain Abscess↗

PubMedDate not supplied

[Diagnosis and treatment of brain abscesses in children].

Fourty children were treated for brain abscess in the period 1983-1988 at the Neurosurgery Department, Children's Health Centre, Warsaw. Their age was from 4 weeks to 16 years. In 38 cases the treatment was surgical, followed by antibiotic therapy, in 2 cases only antibiotics were given. In 7 cases shunts were implanted for treatment of hydrocephalus developed in infants. Two patients died during the treatment. Problems encountered in various methods of brain abscess treatment are discussed.

Abscess↗

PubMedDate not supplied

NMR imaging of experimental brain abscess: comparison with CT.

An experimental canine model of a brain abscess induced with alpha-streptococcus was imaged in the cerebritis and capsule stages by computed tomography (CT) with intravenous contrast enhancement and by nuclear magnetic resonance (NMR). An NMR imager equipped with a superconducting magnet operating at 3.5 kG was used for several imaging techniques. The NMR images were compared with the CT scans and with gross and microscopic neuropathologic findings. CT showed enhancement of the inflammatory focus at the site of capsule formation while the necrotic center retained its low-density appearance. Spin-echo NMR images demonstrated the presence and extent of abnormal infected brain tissue more accurately than contrast-enhanced CT. Spin-echo images showed the necrotic center, the surrounding inflammatory zone, and peripheral edema without discriminating distinctly between the latter two zones. Inversion-recovery NMR images depicted a lesion of lesser extent, showing the necrotic center circumscribed by the surrounding edematous brain tissue. The inversion-recovery technique was best for demonstrating gray- and white-matter contrast in normal brain and depicted edema as loss of contrast between the gray and white matter. NMR offers some advantages over CT in imaging brain abscess, and the variety of NMR imaging techniques is useful for characterizing the different pathologic areas.

Animals↗

PubMed2003

[A case of a bacterial brain abscess presenting as symptoms of 'sudden stroke-like' onset].

We report a case of a bacterial brain abscess presenting symptoms of 'sudden stroke-like' onset, associated with infective endocarditis. A 59-year-old woman experienced a sudden stroke-like onset of left hemiplegia. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed on the day of ictus. No lesion responsible for the symptom was seen on either CT or a T2 weighted image (T2WI), but a diffusion-weighted image (DWI) revealed focal increased signal intensity in the right frontal lobe. An initial diagnosis of acute embolic infarction associated with infective endocarditis was made. Although the patient's neurological state had been stable, motor paresis of her left extremities became worse starting one month after her admission. MRI with gadolinium-diethylenetriaminepenta-acid (Gd-DTPA) at 37 days after admission showed an irregular-shaped ring-enhancement lesion located at the same place as the initial infarction, and in the left frontal lobe. Surgical drainage of the lesion in the right frontal lobe was performed, and diagnosed as a bacterial abscess. The exact mechanism of a bacterial brain abscess presenting with 'sudden stroke-like' onset is unknown, but various hypotheses have been proposed. One is that paroxysmal septic emboli lead to abscess formation within or near the area of embolic infarction. Our case showed that the creation of a brain abscess followed embolic strokes, and that this hypothesis was demonstrated by MRI carried out on the day of ictus.

Brain Abscess↗

PubMed2001

[Brain abscess in retroperitoneal perforated colonic diverticulitis].

The most frequent complications in diverticular disease are local abscess, perforation with peritoneal sepsis, fistula and ileus. Extraabdominal manifestation is an actual rarity. A haematogenous bacterial spread via portal vein with formation of liver abscess has seldom been described. But a complicated diverticular disease as a cause for a brain abscess is an absolute rarity. Our case presents a patient with brain abscess caused by asymptomatic, retroperitoneal perforated colonic diverticulosis. We discuss diagnostic steps both in diverticular disease and brain abscess and different surgical options in the treatment of colonic complicated diverticular disease.

Abdominal Abscess↗