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PubMed2001

Brain abscess in patients with hereditary hemorrhagic telangiectasia: case report and literature review.

Hereditary hemorrhagic telangiectasia (HHT), or Osler-Weber-Rendu disease, affects multiple organ systems. Brain abscess is a potential complication, and this disease carries a high mortality. In the setting of HHT the abscess most likely results from paradoxical septic emboli or bacterial seeding of an ischemic portion of the brain after paradoxical sterile emboli. Brain abscess is the diagnosis that must be ruled out in patients with HHT presenting with new onset neurologic symptoms. The clinician can be misled by seemingly benign and nonspecific symptoms, signs, and laboratory test results. Appropriate diagnostic imaging with computed tomography or magnetic resonance imaging of the head is mandatory. We present a case of brain abscess in a patient with HHT presenting to the Emergency Department. The review of the literature deals with the pathophysiology and manifestations of HHT with particular focus on the pathologic and clinical features, and management of cerebral abscess in this setting. Differences between patients with brain abscess with or without HHT are highlighted.

Brain Abscess↗
PubMedDate not supplied

Brain abscess due to Streptobacillus moniliformis and Actinobacterium meyerii.

This paper deals with a case of brain abscess due to Streptobacillus moniliformis (the cause of the streptobacillary type of rat-bite fever) and Actinobacterium meyerii. Brain abscesses due to these micro-organisms are rare. The possible causative mechanisms in this particular case and the diagnostic and therapeutic management of brain abscesses in general are discussed.

Actinomycosis↗
PubMed2006

Brain abscess in a neonate: an unusual presentation.

BACKGROUND: Neonatal brain abscesses are very rare and their clinical presentation is specific for this age group. They usually occur as a complication of bacterial meningitis or septicemia. They are most often caused by gram-negative organisms, and mortality and morbidity are still significant in this particular group of patients in spite of antibiotics and modern radiological tools. METHODS: We report an unusual case of a multiloculated brain abscess in a term neonate caused by Staphylococcus aureus. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, mother's disease, or immune defect. The onset of infection in this case was not clear and image features mimicked a brain tumor in the initial evaluation. The infant was successfully treated by primary surgical excision of the lesion and a 6-week total course of intravenous antibiotics. CONCLUSION: The interest of this case lies in the rarity of the causative organism and the atypical features of clinical and neurological images in a term neonate.

Brain Abscess↗
PubMed1976

[Brain abscess secondary to pulmonary arteriovenous malformation, case report (author's transl)].

A case of brain abscess in the right parietal lobe secondary to pulmonary arteriovenous malformation of the right lung is presented. A 27-year-old man was admitted for headache and left homonymous hemianopsia. CAG, VAG and brain scan detected brain abscess of the right parietal lobe which was successfully removed surgically. He had been noted to have generalized cyanosis and club finger which corresponded to polycytemia and hypercapnia on examination. Subsequently pulmonary arteriovenous malformation was found in the right lower lobe of the lung which was also successfully excised by thoracic surgeons. Brain abscess was caused by peptostreptococcus anaerobius.

Adult↗
PubMed1995

Post-traumatic brain abscess: experience of 36 patients.

Thirty-six patients with post-traumatic brain abscess were managed over 18 years. They constituted 9.3% of all brain abscesses encountered during the same period. The head injury was associated with an external compound fracture in 20, internal compounding in three and was closed in 13 patients. The mean interval between the time of injury to presentation with an abscess was 113 days. This did not differ significantly in patients with closed and compound head injury, and amongst patients who had wound sepsis and with clean wounds after the injury. The occurrence of focal neurological deficit was more frequent in patients with a closed injury (p < 0.05). Twenty patients underwent primary excision of the abscess with recurrence of the abscess in one patient. Of the 14 patients in whom the abscess was initially aspirated, eight patients required a subsequent excision. Excision was required in 18 patients (94.7%) with external compound injury, five (50%) of those with closed injury and in all patients with internally compound injuries. Two patients had 'coned' and died before they could be operated upon. The operative mortality in the absence of signs of herniation preoperatively was 12.5% in patient with compound injury and none among patients with closed head injury.

Brain Abscess↗
PubMed2004

Brain abscess secondary to the middle ear cholesteatoma: a report of two cases.

We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected. The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.

Anti-Bacterial Agents↗
PubMed1999

Type A immunoglobulin deficiency presenting as a mixed polymicrobial brain abscess: case report.

OBJECTIVE AND IMPORTANCE: We present a case report of a patient with a left frontal brain abscess. Cultures obtained from the abscess at the time of surgery were identified as dental flora known to establish a synergistic relationship in polymicrobial infections. This type of synergistic relationship makes the clearance of an infection more difficult for an intact immune system. A serum immunoglobulin (Ig) Type A deficiency was identified postoperatively. This immunodeficiency may have contributed to the development of the abscess. CLINICAL PRESENTATION: The patient presented with headaches and photophobia. Computed tomography of the head performed with intravenously administered contrast demonstrated a left frontal brain abscess. INTERVENTION: The patient was operated on through a left frontal approach, carefully avoiding the frontal sinus. The abscess was aspirated, and the patient was treated with intravenous antibiotics for several weeks. Postoperatively, the patient did well. There were no signs of enhancement on follow-up computed tomographic scans at 7 and 12 months postoperatively. CONCLUSION: Through a comprehensive immunological workup, an IgA deficiency was identified postoperatively. Although the deficiency of a single type of Ig may be asymptomatic, complications from recurrent or chronic bacterial infections may occur. The deficiency of IgA, combined with a synergistic polymicrobial infection, contributed to the development of an intracranial abscess. A patient presenting with a brain abscess without any predisposing medical history should be evaluated for an underlying immune deficiency.

Adult↗
PubMed2001

Clinical presentation and outcome of brain abscess over the last 6 years in community based neurological service.

Sixty patients with brain abscess were treated at the Neurosurgical Unit of the Department of Surgery, Hospital Universiti Sains Malaysia between January 1990 and December 1996. A retrospective study was done and data were collected from the computerise d registry of the Record Unit of Hospital Universiti Sains Malaysia. Good results were achieved in patients who were both treated surgically and medically. There were only twelve deaths in this group. The main factor that influences morbidity and mortality of brain abscess is the clinical presentation on admission. The mortality was high in patients treated solely by medical means. Death was common in patients who presented with acute onset of symptoms of less than one week duration and those with poor mental status. Brain abscess is common in the East Coast population of peninsular Malaysia, probably due in part to lower socioeconomic status. Efforts should be directed towards prevention of infection and early recognition and management.

Adolescent↗
PubMed2004

Brain abscess due to Nocardia otitidiscaviarum: report of a case and review.

We present a case of brain abscess caused by Nocardia otitidiscaviarum in an immunocompromized 44-y-old male. Only 7 other cases of N. otitidiscaviarum brain abscess or involvement were found in the literature. The mortality was 75% despite treatment among cases reviewed. There is a lack of therapeutic guidelines regarding brain abscesses due to Nocardia.

Adult↗
PubMed1993

Review of 140 patients with brain abscess.

There were 140 cases of brain abscess treated between 1980 (when CT scanning became available) and June 1991. These arose by spread of a contiguous area of infection in 37%, and from another identified cause in 22%; the origin was undetermined in 41%. There were multiple abscesses in 11%. The abscess was < 2 cm in diameter in 21%. In two-thirds of the patients, the intracranial pressure was raised, there were localizing neurologic signs in 33%, and in 28% there were epileptic seizures. The computed tomographic (CT) feature of an abscess in the capsular stage was a thin, regular, and uniform, ring-like enhancement. In the cerebritis stage, nine out of 17 patients showed a uniform enhancement throughout the lesion. Since 1989, 14 cases have been investigated with magnetic resonance imaging (MRI). In 11, the abscess was in the capsular stage. In both T1- and T2-weighted images, the abscess and the surrounding inflammatory area were well demonstrated, and with T2-weighting, the capsule showed a low-intensity signal clearly. In the three abscesses in the cerebritis stage, there was a uniform abnormality with indistinct margins between the abscess, inflammatory edema, and surrounding grey and white matter. All cases received a combination of wide-spectrum antibiotics before the organism was identified; and later the medication was administered according to bacteriologic indication of the organism of 112 cases, organisms were identified in 71%, with anaerobic organisms occurring in 30% of these. In 127 cases, surgical treatment was used: either repeated aspiration, excision or both. We treated 13 cases that had small, early, or multiple abscesses with antibiotics only. The mortality with surgical treatment was 7.9%, and no case treated conservatively died.

Adult↗
PubMed2003

Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases.

Sixty-six consecutive patients with brain abscesses referred to a department of neurosurgery during a 10-year period and treated with cefotaxime were studied retrospectively by means of a prospectively designed protocol whose main areas of emphasis were duration of antibiotic treatment, sterilization rate, clinical outcome in relation to prognostic factors, and side effects. Sixty-two of these patients were treated additionally with metronidazole, and surgery was performed in 53 patients. Mental status was altered in 33 patients, 11 of whom were comatose. Rupture of the abscess into the ventricles occurred in eight patients. Death was attributable to brain abscess formation in three patients (4.5%). Forty-six percent of the surviving patients recovered without any neurological deficits. Reversible adverse reactions, which occurred in 38 patients, were the most common reason for withdrawal of cefotaxime. In 76% of these cases, there was a significant improvement before the onset of the adverse reaction. The median duration of parenteral antibiotic treatment was 36, 41, 22, and 46 days in patients treated with excision, aspiration, evacuation of subdural empyema, and antibiotics alone, respectively. Taking prognostic factors into consideration, mortality attributable to brain abscess was lower than previously reported. This finding, along with the abscess sterilization results, indicates that cefotaxime in combination with metronidazole is a highly effective treatment but is associated with a high frequency of reversible side effects. The results indicate that a shorter duration of treatment should be investigated.

Adolescent↗
PubMed2000

Serious infections of the central nervous system: encephalitis, meningitis, and brain abscess.

Central nervous system infections in adolescents range from the diffuse cerebritis of encephalitis to the regional inflammation of meningitis, and very focal disease of brain abscess. Clinical presentations reflect this wide spectrum, with encephalitis primarily characterized by altered mental status, meningitis by fever, headache, and neck stiffness, and brain abscess manifesting localizing findings. Encephalitis and viral meningitis are frequently caused by the seasonal enteroviruses and arboviruses, while most adolescent bacterial meningitis is due to Neisseria meningitidis and Streptococcus pneumoniae. The microbiology of brain abscess reflects underlying host risk factors. Gram-positive cocci are seen in patients with congenital heart disease, while respiratory flora including anaerobes are associated with sinus or otic disease. Lumbar puncture to characterize and culture the CSF remains the optimal test for the diagnosis and management of encephalitis and meningitis, while CT-guided needle biopsy may be both diagnostic and therapeutic for brain abscesses. New diagnostic tests include the use of PCR. A variety of safe and effective treatment regimens exists for most bacterial infections as well as for some herpesvirus infections. New vaccines are under study to further control bacterial meningitis.

Adolescent↗
PubMed2000

Management and outcome of brain abscess in renal transplant recipients.

Although infection is the commonest central nervous system complication following renal transplantation, brain abscess is uncommon. Over the last 11 years, five renal transplant recipients who had brain abscesses were treated by computed tomography (CT)-guided stereotactic aspiration. Three patients had a fungal abscess, one a tuberculous abscess and the other had a methicillin-resistant Staphylococcus aureus abscess. One patient required a craniotomy for the excision of a fungal abscess which was persistent after two CT-guided stereotactic aspirations. The survivors in this group are the patient with a tuberculous abscess who is alive and well 5 years after diagnosis, and another with a dematiaceous fungal abscess (phaeohyphomycosis). CT-guided stereotactic surgery is minimally invasive, and can safely be performed in these patients. It often leads to an aetiological diagnosis in renal transplant recipients with brain abscesses. Specific antibiotic management directed towards the causative organism rather than empirical treatment can be instituted following the procedure. Although the ultimate prognosis in these patients is bleak even with specific antibiotic therapy, an occasional patient might have a good outcome with prompt and appropriate therapy.

Adult↗
PubMed1982

[Use of the scanner in diagnosis and therapeutic surveillance of brain abscess].

Comparison from 102 cases of brain infections has been done between 2 periods: before and after 1978. The use of CT scan in routine since 1978 has not changed the number of patients diagnosed in acute phase (less than 15 days); but diagnosis was done before 2 days in 37% after 1978 and in 27% before 1978. However frequency of consciousness disorders is equal in both groups: 55%. By a semi-statistical analysis on 40 cases, 10 CT scan datas have been tested according to their sensibility and specificity to the diagnosis of brain abscess; 4 datas have a satisfying sensibility and specificity and are more accurate than the others: regularity of the shape, regularity of the enhanced ring; enhancement after injection, surrounding edema. Survey of 40 cases by CT scan has permitted to determine the average delay of disappearance of mass effect (20 days), of disappearance of the abscess (44 days) and the cicatricial aspects according to the treatment: puncture or excision.

Brain Abscess↗
PubMed1977

[Radioisotope scintigraphy in the diagnosis of brain abscesses].

The authors report two cases of brain abscess presenting considerable diagnostic difficulties despite neuroradiological investigations (angiography, pneumoencephalography, ventriculography). Brain scintigraphy was found to be most reliable in the detection and localization of focal intracerebral changes and made possible successful surgical intervention. In both cases the proper diagnosis of abscess was made only during the operation since the clinical syndrome did not suggest this type of lesion. Brain scintigraphy made possible localization of the lesions in the parietal and occipital areas; results of angiography and pneumoencephalography are not quite often reliable if lesions are situated in these areas.

Adult↗