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PubMed1992

Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung.

On the basis of the data provided by literature the majority of patients with an arteriovenous malformation of the lung who develop a brain abscess suffer from hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease. Only nine cases of brain abscesses in which the arteriovenous malformation of the lung was isolated have been described and in all of these, clinical signs and/or alterations in the laboratory data were detected which can be attributed to the arteriovenous malformation itself. The case taken in this article would seem to be the first case of a recurrent brain abscess in a patient not suffering from Rendu-Osler-Weber with a completely asymptomatic arteriovenous malformation of the lung, both from the clinical point of view and from laboratory data. The authors stress the appropriacy of an angiographic pulmonary study in cases of recurrent brain abscesses, even where the chest X-ray has been negative.

Adult↗

PubMed1994

[A case of brain abscess of the basal ganglia which resulted in disastrous outcome due to ventricular ruptures].

A case of deep-seated brain abscess that ruptured twice into the ventricle and resulted in death is presented. A 45-year-old man had experienced pyrexia and headache for 3 days before admission. On admission he was somnolent (GCS: 13) but there were no abnormal neurological findings except nuchal rigidity and Kernig's sign. Computed tomography (CT) scan showed a ring enhanced mass near the left caudate head and dilated ventricles. In comparison with CT performed at the former hospital it was diagnosed that a rupture into the ventricle of the brain abscess had occurred. Ventricular drainage was performed at once and white purulent cerebrospinal fluid was obtained. Thereafter, he was treated with some antibiotics and his conditions seemed to stabilize for a while. Serial CT images demonstrated that the size of the abscess seemed to be enlarging. Just when we planned to undertake stereotactic aspiration, the second ventricular rupture occurred and he died. According to this case, it is suggested that once a deep-seated brain abscess near the ventricular system is suspected, it should be aspirated by means of CT-guided stereotactic surgery immediately.

Basal Ganglia Diseases↗

PubMed1978

[Brain abscess discovered 38 years after head injury (author's transl)].

We reported a case of delayed brain abscess following a penetrating gun-shot injury. The brain abscess surrounding retained intracranial fragments of bone and shell was found 38 years after head injury. The patient's only symptom had been minimal weakness of the right arm. This case was treated surgically with good results. The long period of silent infection was discussed.

Aged↗

PubMed2005

Tuberculous brain abscess in AIDS patients: report of three cases and literature review.

OBJECTIVE: Clinical description of tuberculous brain abscess in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Clinical case report and review of the literature from January 1981 to January 2003 using the MEDLINE database. RESULTS: The authors report three cases of tuberculous brain abscess in AIDS patients and review nine similar cases. The mean age was 30 years (range: 18-56 years) with seven patients being male. Five (42%) were intravenous drug users, had prior history of extra-cerebral tuberculosis, and presented alterations on chest radiograph. Tuberculin skin test was anergic in six (75%) of eight patients. Three patients of nine had a CD4+ cell count higher than 200 cells/microL, and three had a CD4+ cell count lower than 100 cells/microl. All but one patient had a brain computerized tomography scan with a single lesion. All patients received anti-tuberculous treatment and underwent surgical procedures. Most patients (75%) showed appropriate clinical responses. CONCLUSION: Tuberculous brain abscess must be considered in the differential diagnosis of intracranial mass in AIDS patients. A careful epidemiological, clinical and laboratory evaluation may guide a diagnostic suspicion. Surgery combined with specific anti-tuberculosis treatment seems to determine a good outcome.

AIDS-Related Opportunistic Infections↗

PubMed1989

[Nocardial brain abscess: case report].

A 25-year-old man, who was slightly immunosuppressed, presented headache and right motor weakness due to multiple brain abscesses disseminated from lung abscess. They were diagnosed, by bacteriological examination, as nocardial brain abscesses (nocardia asteroides) 4 weeks after the first operation. In spite of delay in the diagnosis, he was relieved by operations (three times) and chemotherapy including high doses of Sulfamethoxazole-Trimethoprim. He was eventually discharged. We stress the necessity of early diagnosis and the efficacy of Sulfamethoxazole-Trimethoprim for nocardial brain abscess.

Adult↗

PubMed1994

Brain abscess and subdural empyema.

Notable contributions have been made recently in the diagnosis and management of brain abscesses and subdural empyema. Several articles present an international perspective, echoing much of the Western literature, including a profound decrease in mortality with the availability of computed tomography and early recognition and treatment. Diagnostic studies have highlighted the superiority of magnetic resonance imaging to computed tomography in the detection of subdural empyema and the potential value of positron emission tomography. Novel diagnostic tools, including 99mTc-hexamethylpropyleneamine oxime leukocyte scintigraphy and C-reactive protein levels, have been evaluated and show great promise. Surgical studies comparing stereotactic drainage with craniotomy for brain abscesses and burr hole versus craniotomy drainage of subdural empyema suggest the efficacy of these more limited procedures. Local instillation of antibiotics is a potentially effective adjunct for refractory brain abscesses. Recent studies suggest that the most significant predictors of poor outcome are the patient's level of consciousness and the rapidity of disease progression prior to the initiation of treatment.

Brain Abscess↗

PubMed1982

Short term, high dose corticosteroids in computed tomographic staging of experimental brain abscess.

A short term, high dose corticosteroid treatment protocol was investigated to determine its clinical utility in staging an experimental brain abscess. Corticosteroids were shown to decrease the degree of contrast enhancement of brain abscess 12 h after administration but the magnitude of the effect was not consistent enough to be clinically useful in staging. The corticosteroid effect progressively diminished as the inflammatory lesion encapsulated over time. This effect emphasized that a decreasing ring diameter and not diminished contrast enhancement should be the CT criterion for brain abscess resolution.

Adrenal Cortex Hormones↗

PubMed2002

Chronological change of brain abscess in (1)H magnetic resonance spectroscopy.

We studied chronological magnetic resonance spectral changes in brain abscesses before and after medical and/or surgical treatment. We examined five patients with MRI imaging and (1)H magnetic resonance spectroscopy (MRS) on two or more occasions, using two volume-of-interest patterns, and saw chronological changes related to the evolution of the abscess. A spectrum specific for brain abscess was found in three of the five cases, while two showed a single lactate peak in the first study. In two cases, phenylalanine or alanine appeared in the second study. We observed the disappearance of the specific spectra and a single lactate peak following surgery. Only one patient showed different spectra in different volume of interest.

Adolescent↗

PubMed1991

A case of Rhodococcus equi brain abscess.

We treated a patient with acquired immunodeficiency syndrome for a brain abscess caused by Rhodococcus equi, an actinomycete that usually infects the lung in immunosuppressed hosts. Rhodococcus equi brain abscess is an extremely rare lesion that has never been reported in a patient with acquired immunodeficiency syndrome. The infection was cured by lengthy therapy with multiple antibiotics after aspiration of the lesion to identify the infective organism and determine its sensitivity to antibiotics.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Patent foramen ovale as a possible risk factor for cryptogenic brain abscess: report of two cases.

OBJECTIVE AND IMPORTANCE: Patent foramen ovale (PFO) has been suggested as a potential source of paradoxical embolism. A higher prevalence of PFO in ischemic stroke of unexplained cause has been recognized. Brain abscesses are commonly associated with a contiguous focus of infection, hematogenous spread from a distant focus, or cranial trauma. However, no predisposing factors, including a distant focus with unknown cause, are identified in approximately 15 to 30% of reported cases. CLINICAL PRESENTATION: We encountered two patients with brain abscess presumably caused by dental infections. Both patients displayed PFO, through which right-to-left atrial contrast shunting was revealed by transesophageal echocardiography. Although the radiological location of the abscesses suggested hematogenous spread as a cause, the patients had no arteriovenous shunting other than the PFO, despite exhaustive investigations for a potential infectious route. The patients displayed no definite focal orofacial inflammatory signs during the postoperative course despite diagnosis of pyorrhea alveolaris or periodontitis. INTERVENTION: In Patient 1, the abscess was aspirated stereotactically, and in Patient 2, the abscess disappeared radiologically after high-dose antibiotic treatment. CONCLUSION: The mechanism of brain abscess formation putatively related to PFO should be different from that related to common dental sepsis. Analysis of these cases suggested that infectious embolism from a latent or even identifiable focus through the PFO may be an underrecognized cause of brain abscess, in contrast to simple seeding of the brain via transit of the infecting bacteria through the valveless emissary veins.

Adult↗

PubMed1991

Psychosocial sequelae of brain abscesses.

A group of 13 patients recovered after surgical treatment of brain abscess was examined. The patients were tested using WAIS-R, WMS, BVRT and CMI 3 methods. The reports of two patients not examined in person were also evaluated. Pathological deterioration of mental capacities was found in 8 cases, psychopathological symptomatology was recorded in 5 cases. One patient was amaurotic. The reports of two patients in the examination not present gave the diagnosis of ethylism and personality degradation in one case. The results obtained suggest that mental and physical disabilities occur after surgical treatment of brain abscess.

Adult↗

PubMed1991

[Multiple aspergillus brain abscess complicated with systemic lupus erythematosus--case report].

A 15-year-old female was hospitalized for the treatment of systemic lupus erythematosus complicated with nephritis. She improved with administration of steroid hormones and an immunosuppressant, plasma exchange, and dialysis. However, a lung abscess developed 6 months after admission, and multiple brain abscesses appeared 2 months after the onset of the lung abscess. The lung abscess faded with oral administration of fluocytosine and intravenous administration of miconazole, but the brain abscesses enlarged. Intrathecal administration of miconazole was not effective. Therefore, the abscess in the right frontal lobe was surgically removed and an Ommaya's reservoir was placed in the anterior horn of the right lateral ventricle. Aspergillus was identified in the removed abscess. Subsequently, miconazole was administered intraventricularly through the Ommaya's reservoir 10 mg daily for 1 month. The abscesses in the left parietal lobe gradually diminished. One year later, she complained of right hypesthesia again. Computed tomography scan revealed enlargement of the abscess. Miconazole was administered intravenously and intraventricularly for 1 month. Second craniotomy was performed 16 months after the first surgery and the abscess was completely removed. She was discharged with mild hypesthesia of the right leg. It is concluded that intraventricular administration of miconazole through an Ommaya's reservoir is an effective therapy for central nervous system aspergillosis.

Adolescent↗

PubMed1989

[Brain abscess following cerebral infarction: a case report].

The authors report a case of brain abscess following cerebral infarction. A 73-year-old man was admitted to our clinic with symptoms of right hemiparesis and total aphasia. CT scan revealed abnormal low density area in the left fronto-temporo-parietal region. Cerebral angiography demonstrated occlusion of the left middle cerebral artery at the M1 portion. On the 16th hospital day, an episode of generalized seizure with high fever appeared, and intermittent high fever persisted thereafter. Two months after admission, CT scan revealed several cystic lesions with marked ring enhancement at the site of cerebral infarction, suggesting multiple abscesses. Aspirations of left frontal and parietal abscesses were accomplished and the cultures of the pus disclosed Proteus vulgaris. Due to progressive hydrocephalus, a ventriculoperitoneal shunt was constructed one month later. Repeated CT scans showed a gradual diminution of the abscesses. It is considered that the blood-brain barrier is broken and the local immunological system against bacteria may be weakened when the brain is damaged by ischemia. Brain abscess seems to be developed in such circumstances even under the influence of transient bacteremia which originates in other parts of the body. Therefore the possibility of cerebral abscess should be suspected if patients with cerebral infarction suffer from the symptoms such as fever, neck stiffness or disturbance of consciousness.

Aged↗

PubMed1989

Late brain abscess years after severe cerebrocranial trauma with fronto-orbitobasal fracture.

An 8-year-old boy suffered severe craniocerebral trauma with left-sided fronto-orbitobasal fracture. The CT scan showed minor subdural air inclusions. The child recovered well and had no clinical signs of aftereffects. Eight years after the accident, symptoms of intracranial pressure developed progressively with nuchal rigidity and elevated temperature. The CT showed an extensive left fronto-orbitobasal abscess. The intraoperative finding was a brain prolapse both into the frontal sinus and into the ethmoidal cavity with a large dura-bone defect at the site of the former fracture line, which was closed with refobacin-bone-meal fibrin sealant plasty and glued periostal patch. The postoperative course was unremarkable. Evidently, the accident had caused a brain prolapse into the bone defect, which prevented liquorrhea. Due to the lack of bone and dura barrier, a late brain abscess developed in the course of sinusitis. In such cases, primary surgical revision seems to be indicated.

Brain Abscess↗

PubMed1980

Quantification of plasminogen activator activity associated with herpesvirus-transformed cells.

Herpesvirus-transformed cell lines were examined for plasminogen activator (PA) activity using a quantitative assay. Previous results of cold fibrin overlay assays indicated that herpesvirus-transformed hamster cell lines produce fibrinolytic activity. Quantification of this activity involved the use of an 125I-fibrin lysis assay in which medium previously incubated with transformed or normal cells was tested for its ability to lyse 125I-fibrin polymers. This assay indicated an enhanced production of plasminogen-dependent fibrinolytic activity by transformed hamster cells compared to hamster embryo fibroblasts. The kinetics of secretion failed to reveal a significant difference in plasminogen activator activity in cells transformed by either herpes simplex virus types 1 or 2 (HSV-1 or HSV-2); however, transformed cells exhibited a significant increase in activity over non-transformed cells. Further characterization of PA activity associated with cells transformed by HSV-1 or HSV-2 has revealed that the protease is secreted and can function extracellularly. Extracellular PA activity produced by HSV-transformed cells is detected more efficiently than the cell-associated enzyme. Extracellular PA can be induced in two different species of cells by infection with partially inactivated HSV-2. Lytic infection of human embryo lung cells by HSV-2 strain 333 did not enhance activity, but infection of these cells with virus inactivated by u.v. irradiation resulted in increased PA levels from the cells. Increased enzyme levels were also detected in hamster embryo fibroblasts infected with partially inactivated virus. Further investigation of this enzyme function may determine whether increased levels of protease will indicate oncogenic transformation in vitro by herpesviruses.

Animals↗

PubMed1988

Pseudallescheria boydii brain abscess. Complication of an intravenous catheter.

An adult patient survived a brain abscess with Pseudallescheria boydii. She received intraventricular miconazole, 20 mg every 72 hours (minimal inhibitory concentration = 0.4 microgram/ml), and surgery. The abscess resulted from an infected central venous catheter (Port-A-Cath) and steroid therapy. Miconazole caused a ventriculitis. There are 12 reported cases of P. boydii brain abscesses from 1965 to 1985 with only two survivors.

Adult↗

PubMed1982

Brain abscess and its surgical management.

A series of 56 patients with brain abscesses who were treated over a period of 23 years is reviewed. Patients with posttraumatic infections were not included. The operative mortality was 11%. Aspiration of purulent material, radical excision of the abscess, drainage of pus, or a combination of these procedures was used according to the patient's condition and the location of the abscess. The relatively low mortality may be related to the preoperative condition of these patients, who were operated upon in the subacute or chronic stage of their disease. Conservative surgery, especially when functionally important parts of the brain are involved, helps to keep the postoperative neurological deficit as low as possible. Computerized tomography is of primary importance in localizing, diagnosing, and following the evolution of a brain abscess.

Brain Abscess↗

PubMed1997

[Syringomyelia appearing in a short term after brain abscess].

We describe a rare case of syringomyelia that developed within only 4 months after the cure of the focal cerebritis and abscess. An 18-year-old man who had suffered from meningitis and brain abscess 1.5 years before, presented with pain and sensory disturbance in his left shoulder. Magnetic resonance image (MRI) showed a syrinx formation extending from the upper cervical to the lower thoracic cord. Investigation by MRI during the course of the brain abscess had the appearance of posterior cerebellar arachnoid cyst 3 months after the onset of brain abscess and syrinx developed within 9 months. After posterior fossa decompression and reopening of the Magendie's foramen, his symptom and MRI abnormality improved after one month. In contrast to reported cases of syringomyelia following cerebritis, syrinx formation in our case appeared in relatively a short time. We speculated that basal arachnoiditis and the formation of posterior cerebellar arachnoid cyst caused syrinx formation in a short term after cerebritis.

Adolescent↗