[SPONTANEOUS PNEUMOCEPHALUS AS A COMPLICATION OF OTOGENIC BRAIN ABSCESSES].
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Brain Abscess↗
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[Brain tumor simulating rhinogenic brain abscess].
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Brain Abscess↗
Brain abscess due to Pasteurella multocida.
The patient was a 26-year-old man who complained of headache and vomiting. On examination, there was nothing abnormal, but the edge of the right optic papilla was not clear. His temperature was 38.5 degrees C, pulse 96/min, blood pressure 120/80 mmHg. A space-occupying lesion in his fronto-dextra cupular part was found by CT scanning. He had a 12-year history of chronic purulent otitis. The diagnosis was a brain abscess in the fronto-dextra cupular part. The brain abscess was extracted and Pasteurella multocida was isolated from the dark brown pus draining from the abscess. The patient recovered through proper antibiotic therapy based on a sensitivity test. Reports of infections caused by this organism in foreign countries very widely from local infections due to bites and scratches by cats, dogs etc. to general infections such as infections of the respiratory tract, sepsis and meningitis. However, Pasteurella multocida brain abscesses are rare. Pasteurella multocida is a Gram-negative short rod which is best known as part of the mouth flora and as a pathogen causing septicemia in many domestic animals, such as cats, dogs etc.. Infection in man results mainly from animal bites or scratches. It has been reported that Pasteurella multodida can cause human septicemia, meningitis, respiratory tract infection, conjunctivitis and other infections. We isolated a strain of Pasteurella multocida from the pus of a brain abscess following chronic purulent otitis on August 6, 1990.
Adult↗
[Early diagnosis of bacterial brain abscesses: interest of diffusion-weighted MRI].
Three cases of bacterial brain abscesses, in immunocompetent patients, are reported. In all these cases, the diffusion-weighted magnetic resonance (MRI) with apparent diffusion coefficient (ADC) map has permitted an early diagnosis and a rapid treatment. This emergency MRI showed in the three cases a low signal on TI-weighted images, a high signal on T2-weighted and echo-planar images, and a decrease of ADC (0.36- 0.49 x 10(-3) mm2/s). So, this new MRI technique provides an available and rapid element in the brain abscess diagnosis which often remains a complex clinical and radiological diagnosis.
Actinomycosis↗
Multiple brain abscesses complicating treatment of a severe burn injury: an unusual case report.
Death after burn injury is usually due to complications, of which bacterial causes are dominant. We treated a patient with a burn injury who had the unusual complication of multiple brain abscesses, which were caused by methicillin-resistant Staphylococcus aureus (MRSA). The patient, a 27-year-old man, had MRSA septicemia on day 9 and pneumonia on day 18. Hemiparesis, which was the first manifestation of brain abscesses, occurred on day 27. Although antibiotics were administered aggressively, the infection was never resolved, and the patient died on day 50. Brain abscesses and MRSA infection are still major problems in the treatment of burns. This is the first report of (metastatic) multiple brain abscesses complicating treatment of a burn injury.
Adult↗
Brain abscess--diagnosis and management.
OBJECTIVE: To evaluate the clinical presentation, diagnosis, sources of infection, surgical management outcome and microorganisms involved in the brain abscess in our locality. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The department of Neurosurgery, Chandka Medical College Hospital, Larkana from July 1998 to June 2003. SUBJECTS AND METHODS: All patients who were confirmed cases of brain abscess were entered into the study. Data collected on proforma, contained categories of age, gender, clinical presentation, diagnostic laboratory findings, computed tomography scan reports, associated anomalies, surgical management, culture reports antibiotic therapy, microbiologic features and treatment out come. RESULTS: Out of 82 patients, 58 were males and 24 females. Mean age was 18 years (range 05 months to 55 years). Headache with papilloedema was the commonest presentation (82%). Neurological deficit was present in 46%. A source of infection was present in 89%. Otogenic source was the commonest (63%). CT scan was diagnostic in all (100%) cases. Solitary abscess was found in 79% of the cases while in 21% of the cases multiple abscess were found. Temporal lobe was the commonest site involved (55%). Cultures were found positive for microorganism in 82% of the cases. Bacteriodes (38%) and Streptococci (25%) were the commonest isolates. Burr hole aspiration was done in only 38% of the cases while excision of the capsule along with aspiration was carried out in 62% of the cases. Over all morality was 22% in this series; causes of death were septicemia, ventriculitis and pneumonia. CONCLUSION: Diagnosis with CT scan, appropriate antibiotic therapy and complete removal of abscess along with excision of capsule could reduce the mortality and neurological deficits from brain abscess.
Adolescent↗
Brain abscess: clinical experience and analysis of prognostic factors.
BACKGROUND: Over the past 2 decades, the diagnosis and treatment of brain abscess have been facilitated by a number of technological advancements, which have resulted in a significant improvement of outcome. The aim of this manuscript is to review our experience, to determine the factors related to the outcome, and to improve the therapeutic strategy for this disease. METHODS: From 1986 to 2002, 178 consecutive patients with bacterial brain abscess were treated at the National Taiwan University Hospital, Taipei, Taiwan. We reviewed their clinical presentation, bacteriology, treatment, and outcome retrospectively. Groups were compared by chi2 test, Fisher exact test, or t test as appropriate. Multivariate logistic regression with backward selection was used to select the set of covariates that were independently associated with outcome. RESULTS: One hundred eleven patients (62%) had favorable outcome, 14 patients (8%) had severe disability, 9 patients (5%) became vegetative, and 44 (25%) died during hospitalization. Patients with better Glasgow Coma Scale (GCS) on admission, no underlying disease, positive culture, or surgical treatment were more likely to have a good outcome. Patients with nasopharyngeal carcinoma, acquired immunodeficiency syndrome, hematologic disease, deep-seated abscess, or medical treatment alone were more likely to have a poor outcome. Multivariate analysis revealed that only GCS, immunodeficiency, and presence of underlying disease related with outcome. CONCLUSIONS: The poor prognostic factors of brain abscess are poor GCS, immunodeficiency, and presence of underlying disease. Aggressive treatment with surgery when indicated and careful management of specimen for culture might improve outcome.
Acquired Immunodeficiency Syndrome↗
Brain abscess associated with congenital heart disease.
Between 1952 and 1985, 25 cases of brain abscess with congenital heart disease were treated at the Department of Neurosurgery, Tianjin Medical College Hospital. Patients' ages ranged from 5 to 38 years. The most common form of congenital heart disease was tetralogy of Fallot, occurring in 13 cases. The abscesses were located in the parietal, frontal, and temporal lobes. The pus from the abscesses was sterile in 13 of 19 cases. In the rest, Streptococcus was the predominant organism. Twenty-three cases were treated by aspiration of the abscess through a burr hole. In two cases, initial aspiration was followed by excision of the abscess. The mortality rate of the whole group was 32%. The etiology of brain abscess in patients with congenital heart disease is discussed.
Adolescent↗
Toxoplasmosis presenting as brain abscesses. Diagnosis by computerized tomography and cytology of aspirated purulent material.
A patient with brain abscesses caused by Toxoplasma gondii is described. Presence of brain abscesses was confirmed by computerized tomography, and T. gondii was identified as the etiologic agent in cytologic preparations of aspirated purulent material from one of the abscesses.
Brain↗
Bacterial brain abscesses: factors influencing mortality and sequelae.
Thirty-nine cases of brain abscess diagnosed since the advent of the computed tomographic (CT) scan were analyzed for factors influencing the outcome. The mortality rate was 13%, and severe sequelae were present in 22% of the survivors. The mean delay between occurrence of the first symptoms and hospitalization was significantly shorter for the 12 patients with poor outcome (death or severe sequelae) than for the 25 who recovered (fully or with moderate sequelae). Moreover, severely impaired mental status and neurological impairment at admission were associated with a poor outcome in terms of both mortality and sequelae. In all cases with fatal outcome or severe sequelae, the diagnosis was made and treatment was initiated within 24 hours of admission. There was no apparent correlation between the outcome and the presence or type of predisposing factors, the radiological, biological, or microbiological findings, or the treatment modalities. Thus, with the advent of the CT scan and the possibility of early diagnosis and treatment, the prognosis of brain abscess appears to be mainly determined by the rapidity of progression of the disease before hospitalization and the patient's mental status on admission.
Adolescent↗
Brain abscess as a complication of orthognathic surgery: diagnosis, management, and pathophysiology.
We present what we believe is the first case of a brain abscess resulting from orthognathic surgery reported in the literature. Although recent advances have significantly improved the treatment of brain abscesses, delays in diagnosis lead to persistent high rates of mortality. Often, the initial symptoms are vague and nonspecific. Commonly, the neurologic status of the patient deteriorates significantly before suspicion is raised and a CT scan is obtained. This case report is intended to benefit all practitioners who participate in the perioperative care of orthognathic surgery patients. Although the occurrence of a brain abscess is rare, it is hoped that this case will heighten the awareness of clinicians to this potential complication.
Adolescent↗
[Aspiration and drainage for a gas-producing brain abscess causing delayed bleeding from the abscess capsule--a case report].
A 65-year-old man was admitted with the complaint of gait disturbance. CT scan revealed a low density lesion in the right parietal lobe. MRI was carried out 3 days after admission, the lesion showing low intensity on T1 WI and T2 WI. Gd-DTPA enhanced T1 WI showing abnormal enhancement surround it. CT scan then revealed a gas bubble in the lesion 12 days after admission, so we diagnosed it as gas-producing brain abscess and aspiration, drainage and irrigation with antibiotics were performed. Although, the brain abscess was reduced in size after the operation, the lesion expanded again 2 weeks after the operation. MRI was performed and the lesion showed iso-intensity on T1 WI and high intensity on T2 WI. Emergent aspiration and drainage were performed and uncoagulated old-hematoma-like matter such as chronic subdural hematoma was removed. As significant neovascularization with inflammatory cells had been detected in the capsule of the brain abscess, we suspected that aspiration and drainage surgery for brain abscess may cause delayed bleeding from the capsule of the abscess. We conclude that attention should be drawn to such a complication.
Aged↗
[Delayed brain abscess as a complication of a CSF shunt].
INTRODUCTION: Infection is a common complication of ventriculoperitoneal shunts, but the formation of a brain abscess related to shunt system is very rare. We present the case of a patient who developed a brain abscess around a ventricular catheter left in place after removing the valvular system. CASE REPORT: This 38 years old woman, underwent ventriculoperitoneal shunting for hydrocephalus secondary to an acoustic neurinoma. During a period of thirteen years she suffered two episodes of meningitis, and after the second one the CSF shunt was removed excepting for the ventricular catheter which appeared to be adherent to the choroid plexus. One year later, a brain abscess arised around that catheter, and both the abscess and the catheter were removed (Proteus mirabilis was the cultured germ). DISCUSSION: In spite of the risks related to removal of a proximal catheter adherent to the choroid plexus, the risk linked to the removal of a ventricular catheter must be counterbalanced with the risk of infection.
Adult↗
Multiple brain abscesses as a complication of pulmonary arteriovenous fistula. A case report.
A case of pulmonary arteriovenous fistula (PAVF) complicated by brain abscess is presented. The incidence of this complication has been quoted to be 1-5%. After reviewing all inpatients in Chang Gung Memorial Hospital from 1977 to 1988, we found a total of 9 cases of PAVF; only one case of PAVF complicated by brain abscess was noted. PAVF is often asymptomatic in the early stage, and its diagnosis may sometimes be quite difficult. However, untreated PAVF tends to enlarge and become symptomatic. There is also a continuing risk of severe neurologic complications. For these reasons, early diagnosis and treatment are essential. In a case of brain abscess associated with unexplained hypoxemia and extra-cardiac murmur on auscultation, PAVF should be considered.
Adult↗
Ultrasound; a method of brain abscess drainage monitoring.
Ultrasound guided percutaneous aspiration was performed in fourteen patients with multiple brain abscesses. A bone defect in the skull served as the site of needle insertion and served to sonographically evaluate the abscesses. Antibiotic therapy was administered in all cases. Repeat drainage was required in 5 cases. There were no complications. In 10 patients complete improvement without CNS lesions was achieved. Three patients suffered from headaches and seizures for a period of 6 weeks following the aspiration. One patient with multiple otogenic abscesses died in spite of multiple efforts to drain the abscesses. Our results demonstrate sonography to be very effective for monitoring brain abscess drainage and follow-up.
Adolescent↗
Brain abscess by citrobacter diversus in infancy: case report.
Citrobacter diversus is closely related to brain abscess in newborn infants. We describe a case of brain abscess by this bacteria in a newborn infant and his clinical and cranial computed tomographic evaluation until the fourth month of life and discuss therapeutic management of this patient.
Brain Abscess↗
Undiagnosed patent foramen ovale presenting as a cryptogenic brain abscess: case report and review of the literature.
A 43-year-old man with no significant medical history but poor oral hygiene presented with fever and new-onset tonic-clonic seizures secondary to a left parieto-occipital brain abscess defined by computed tomography, magnetic resonance imaging, and surgical evacuation. A comprehensive workup looking for a source of infection was unremarkable including computed tomography of the chest, abdomen, and pelvis; blood cultures; and a tagged white blood cell scan. A transesophageal echocardiogram bubble study revealed the presence of a patent foramen ovale (PFO) but no other abnormalities. Culture of the material obtained at surgery revealed flora commonly found in the oropharynx that responded to antibiotic therapy. A review of the literature revealed three other cases in which a brain abscess from flora commonly found in the oropharynx was associated with a PFO. We hypothesize that the underlying mechanism is a significant bacterial load from poor dentition that enters the arterial circulation through a PFO and forms the nidus for a brain abscess. Surgical evacuation is the preferred method for diagnosis and initial treatment. If a brain abscess is identified without any adjacent source of infection, a recent head trauma, or a neurosurgical procedure, then a transesophageal echocardiogram is indicated to exclude a PFO. If a PFO is found, then hematogenous spread of flora normally found in the oropharynx through a right to left shunt should be suspected. Surgical evacuation followed by intravenous antibiotics specific to the identified organisms is warranted. Once the infection is eliminated, anatomic closure of the PFO with good oral hygiene practices may be the best course of action for preventing recurrences.
Adult↗
Brain abscess due to Streptococcus MG-intermedius (Streptococcus milleri).
Three cases of brain abscesses due to Streptococcus MG-intermedius are reported, and the literature pertaining to this subject is reviewed. The importance of careful and complete identification of these etiological agents of infection is stressed. The clinical presentation, the origin of S. MG-intermedius producing brain abscess, and its relation to hepatic abscesses and endocarditis are discussed.
Adolescent↗