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PubMed1989

Brain abscesses in children--a cooperative study of 83 cases.

This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.

Adolescent↗
PubMed1990

Indium-111-granulocyte scintigraphy in brain abscess diagnosis: limitations and pitfalls.

The scintigrams and records of 28 patients referred for indium-111-granulocyte scintigraphy (111In-GS) because of a suspected brain abscess were studied retrospectively. The final diagnosis was brain abscess in 8 patients, brain tumor in 18 patients, and infarct and hematoma in 1 patient each. Five patients not on corticosteroid treatment showed intense focal 111In accumulation in abscesses, whereas an abscess patient receiving a high steroid dose showed no uptake. Two patients studied twice showed intense uptake in abscesses when not on steroid therapy or on a low dose, whereas no uptake was seen when they received high or medium doses. Weak or moderate 111In uptake was observed in nine tumors. Microscopically assessed degree of tumor granulocyte infiltration, vessel proliferation, and hemorrhage did not correlate with the outcome of 111In GS. Our results suggest that intense focal cerebral 111In uptake favors the abscess diagnosis. Abscesses may go undetected, however, in patients on high- or medium-dose steroid therapy.

Adolescent↗
PubMed1996

Discrimination of brain abscess from necrotic or cystic tumors by diffusion-weighted echo planar imaging.

Diagnostic difficulties in discriminating brain abscess from necrotic or cystic tumors using conventional CT and MRI have been reported. In this article, we examine the diagnostic ability of diffusion-weighted imaging to discriminate brain abscess from necrotic or cystic tumors. In previous reports, necrotic or cystic tumors show low signal intensity in diffusion-weighted imaging, indicating a high apparent diffusion coefficient (ADC). In contrast, in our study, high signal intensity was observed in the abscess fluid, associated with low ADC.

Brain Abscess↗
PubMed1997

Treatment of brain abscess associated with ventricular rupture--three case reports.

Three patients presented with brain abscess associated with ventricular rupture. The origins of infection were sepsis, congenital heart disease, and unknown, and the organisms were Gram-negative cocci in one and Streptococcus species in two. Ventricular rupture occurred before administration of antibiotics and caused consciousness disturbance in all three patients. Continuous ventricle drainage was begun and antibiotics were directly administered into the ventricles. Aspiration and drainage from the abscess was also performed in two patients. Ventricular irrigation resulted in an excellent effect in one patient. The outcomes were excellent in two patients and fair in one. Aggressive ventricular drainage in the very early stage and direct intraventricular administration of antibiotics are very important to obtain a favorable outcome in patients with brain abscess and ventricular rupture.

Adult↗
PubMed1996

Imipenem therapy of brain abscesses.

The efficacy of imipenem versus standard chemotherapy (both in addition to neurosurgery) in the treatment of brain abscess was compared in a retrospective study. Cure was obtained in 52 of 60 (86.7%) patients in the standard group, and in 15 of 15 (including 5 patients with multiple brain abscesses) in the imipenem group. Cure without neurosurgery was observed in 2 of 60 (3.3%) and 3 of 15 (20%) of the cases, respectively (p = 0.08). Levels of imipenem in blood, cerebrospinal fluid, and brain pus were above the minimum inhibitory concentrations of most of the abscess isolates. Side effects of imipenem were rare and tolerance was excellent. Imipenem monotherapy (3-4 g/day) for five weeks seems a reasonable therapeutic choice for treatment of bacterial brain abscesses.

Adolescent↗
PubMed2006

Brain abscess in 142 patients: factors influencing outcome and mortality.

BACKGROUND: With the introduction of CT, stereotactic techniques, and broad-spectrum antibiotics, the outcome for brain abscess has dramatically improved. The purpose of this study was to identify prognostic factors by reviewing data on 142 patients with brain abscess. METHODS: Clinical data, including age, sex, medical history, duration of symptoms, initial neurological status, associated predisposing factors, laboratory data, treatment, and abscess characteristics, were considered as potential prognostic factors. A comparison was made between patients with favorable (GOS: moderate disability or good recovery) and those with unfavorable (GOS: death, persistent vegetative status, or severe disability) outcomes at discharge. Univariate (chi(2) analysis or Fisher's exact test) and multivariate logistic regression analyses were used to identify prognostic factors. Data were considered significant when the 2-tailed P value was lower than .05. RESULTS: There were 98 male and 44 female patients (male/female ratio, 2.2). Their average age at diagnosis was 41.5 years (range, 2-84 years). There were 105 patients with a favorable outcome and 37 with an unfavorable outcome. Both univariate and multivariate analyses indicated that patients who were male, had an initial GCS score >12, had no other septic complication, or had Gram-positive cocci grown in abscess cultures had better outcomes. No association was found between outcome and other factors, including age, focal neurological deficits, seizures, laboratory findings, characteristics of the abscesses, associated factors, and treatment modalities. CONCLUSIONS: With the advancement of imaging studies and broad-spectrum antibiotic therapies, the outcome of brain abscess depends on prompt awareness of the diagnosis and effective infection control.

Adolescent↗
PubMed1987

Nocardial brain abscess: diagnostic and therapeutic use of stereotactic aspiration.

Three cases of nocardial brain abscess are presented. All three patients were receiving immunosuppressive therapy at the time of diagnosis. Two patients had cardiac transplantation and the third had periarteritis nodosa. The patients presented with generalized seizures or focal weakness. Accurate localization of the intracerebral mass lesion was obtained from computed tomography (CT) scans, but CT-guided stereotactic aspiration was required for diagnosis and treatment in every case. After Nocardia asteroides was seen on Gram's stain and subsequently identified by culture, appropriate antibiotic therapy was initiated. Both heart transplant patients survived in good neurological condition. We believe that stereotactic aspiration followed by prolonged antibiotic therapy may significantly improve the outcome of patients with nocardial brain abscess.

Adult↗
PubMed1997

Effects of nimodipine and ofloxacin on staphylococcal brain abscesses in rats.

The therapeutic effects of nimodipine (CAS 66085-59-4) and ofloxacin (CAS 82419-36-1) were investigated against experimental brain abscess formation in rats. Nimodipine, a 1,4-dihydropyridine derivative, is chemically related to nifedipine but the smooth muscle relaxant effect preferentially acts on cerebral arteries. Ofloxacin is a member of 4-Quinolone broad spectrum antibiotics. Ninety-six male Sprague-Dawley rats were inoculated intracortically with Staphylococcus aureus and then different groups were treated with either saline, ofloxacin or the combination of ofloxacin and nimodipine. The rate of brain abscess formation and mortality were considerably decreased by nimodipine and ofloxacin therapy. Combination therapy was found histologically to be considerably more effective than ofloxacin alone against brain abscess formation in rats.

Animals↗
PubMed2002

Brain abscess caused by aerobic Gram-negative bacilli: clinical features and therapeutic outcomes.

Thirty-three patients (24 males and nine females) with brain abscesses resulting from infection by aerobic Gram-negative bacilli were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 14 years. Of these, 23 cases developed spontaneously, with the remaining ten postneurosurgery. The organisms most frequently involved were Klebsiella (K.) pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus species and included some rare pathogens, such as Salmonella and Enterobacter species, K. oxytoca, Vibrio and Morganella morganii. Apart from one exception, the locations of the abscess were supratentorial. Twenty-four patients presented with a single abscess, while nine revealed multiple abscesses, with 26 treated surgically and seven with antibiotics exclusively. In total, seven patients died, representing an overall mortality rate of 21%. This study demonstrates that brain abscesses associated with neurosurgical procedures are not rare, accounting for 30% of cases in this study, with K. pneumoniae, Proteus and Enterobacter species the most prevalent of the revealed pathogens. Further, Proteus species were the most prevalent pathogens demonstrated for cases of both otogenic and polymicrobial infections. If brain abscesses are diagnosed for diabetic patients or have a gas-forming appearance, a diagnosis of K. pneumoniae infection should be considered, with particular attention paid to detection of other metastatic septic abscesses. In light of the high mortality rate, early treatment is essential to maximize the chances of survival.

Adolescent↗
PubMed1979

[CT findings in brain abscesses (author's transl)].

Seventeen patients with brain abscesses are reported, some with multiple lesions. The computer tomographic criteria for the diagnosis with and without enhancement are described. The advantages of computer tomography compared with other neuroradiological methods for the diagnosis and follow-up of abscesses is stressed. Good therapeutic results have been obtained from simple puncture of the lesion.

Adolescent↗
PubMed1989

[Brain abscess following intracerebral hematoma].

A 53-year-old man fully conscious was admitted with lt. hemiparesis due to a rt. putaminal hemorrhage. A phlebitis of superficial vein at lt. leg was noted on the 7th hospital day. Following administration of antibiotics, he was afebrile three days after. But local inflammation of phlebitis and leukocytosis continued for over one week. He had no sign of infection thereafter. Four months later, the hemiparesis exacerbated. CT scan revealed a cystic lesion with ring-like enhancement at the site of the hematoma. He was afebrile and had no sign of meningeal irritation. The patient underwent a stereotaxic aspiration of brown turbid pus. The culture from the aspirate was positive for staphylococcus, and histopathological examination of the excised specimen demonstrated a brain abscess with hemosiderin deposits. Follow-up CT scan revealed a progressive diminution in the size of the abs cess. We felt the hematoma represented an area of locus minoris resistentiae and that bacterial seeding of the hematoma from phlebitis resulted in brain abscess formation. Brain abscess formation should be considered as having possibly developed in patients with clinical deterioration after cerebral vascular disease.

Basal Ganglia Diseases↗
PubMed1991

Fungal brain abscesses (aspergillosis/mucormycosis) in two immunosuppressed patients.

Although the mortality rate for fungal brain abscesses in immunosuppressed patients remains unacceptably high, this figure may be reduced if computed tomography or magnetic resonance imaging scans are performed more promptly in susceptible individuals with seemingly mild intracranial complaints. Earlier presumptive amphotericin B treatment and more timely surgical debridement may minimize neurological injury and enhance survival. These assumptions were only tentatively supported by the clinical courses of two patients, one an alert patient with promyelocytic leukemia and an aspergillosis brain abscess who survived, and the other, a comatose intravenous drug abuser with mucormycosis who died.

Adult↗
PubMed1988

Brain abscess after dilatation of esophageal stricture.

Two children, below 15 years of age, developed brain abscesses after esophageal dilation. They were among 40 children treated for supratentorial brain abscesses during the past 10 years. Pus culture of one of the abscesses was peptostreptococcus, which is a common oropharyngeal flora. Clinicians should be aware of this complication since the prognosis is usually satisfactory after prompt treatment.

Brain Abscess↗
PubMed1991

[CT guided stereotaxic biopsy in the treatment of solitary brain abscesses].

CT guided stereotaxic biopsy (aspiration) has been proved as a procedure of choice in the assessment and treatment of a deep-seated sinusogenic, brain abscess in a 54-year old man. The clinical features were atypical; massive neurological deficits (left-side spastic hemiplegia, dysarthria, urinary incontinence) without signs and symptoms of infectious disease. The clinical course and CT finding primarily showed a metastatic neoplastic process surrounded by a large edema in the right fronto-parietal parts so that an abscess or less probably glioma were also considered. From the neurosurgeon's point of view the process was inoperable because of the localization and unknown etiology. Due to recent studies, CT-guided stereotaxic biopsy confirmed the diagnosis of the brain abscess, even when the pus was evacuated by aspiration. CT-guided stereotaxic aspiration together with anti-edematose and target antibiotic therapy, has made possible impressive, complete recovery within ten days. It has been achieved by intravenous administration of Penicillin G (24 million UI per day) during 3 months. The control CT findings and the following clinical course confirmed the resolution of the abscess. The aim was to show a case of a successfully treated brain abscess with CT- guided stereotaxic biopsy (aspiration) and to present great advantages of this method primarily as a safe and effective technique which makes possible minimal traumatization of a patient and fast recovery with minimal risk of invalidity.

Adult↗
PubMed1999

Respiratory foreign bodies and Eikenella corrodens brain abscess in two children.

We report the coexistence of aspirated foreign bodies and brain abscess in two boys. One child had aspirated a metallic needle, and in the other boy partially embedded sunflower seeds were found in the bronchial wall. Both patients had growth of Eikenella corrodens (oral gram-negative flora) from the abscess. Aspirated foreign body in the respiratory tract should be one of the diagnostic considerations if any of the normal oropharyngeal organisms such as E. corrodens is the causative organism of brain abscess.

Anti-Bacterial Agents↗
PubMed1991

Tuberculous brain abscess.

We report a case of tuberculous brain abscess. He developed neurological symptoms inspite of 6 months treatment of pulmonary tuberculosis. His condition improved after surgical excision of abscess and short-course chemotherapy. Routine staining of pus is simple and a very useful technique to detect this entity.

Antitubercular Agents↗
PubMed1987

Brain abscess complicating the use of a halo orthosis.

We report a case of brain abscess complicating the use of a halo orthosis in the treatment of a cervical spine injury suffered during wrestling. Four previous brain abscesses complicating the use of halo orthoses have been reported. All cases of abscess have been associated with overlying infection at the site of pin insertion. Our case and at least one of those previously reported may have been related to tightening of the halo pins after placement. Serious spine injuries occur rarely in wrestlers and are associated with the use of illegal holds and maneuvers in which one athlete is thrown to the mat. The pathophysiology and radiographic appearance of a unilateral facet dislocation are reviewed.

Adolescent↗