SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A 48-y-old woman with an acute Group A streptococcal brain abscess is described. The abscess enlarged rapidly with neurological deterioration and required open drainage and excision. The patient was treated with antibiotics for 6 weeks and recovered completely. Group A streptococcus is a rare cause of brain abscess in the antibiotic era and may require urgent neurosurgical intervention.
Brain abscess is an uncommon complication of the insertion of skull tongs. The two cases reported demonstrate the difficulty that may occur in diagnosis and the high mortality associated with this complication.
A 54-year-old man with primary non-Hodgkin's lymphoma of the thoracic spinal cord developed multiple brain abscesses caused by Pseudallescheria boydii. The patient had received radiotherapy and corticosteroid treatment before developing the brain abscesses. Antemortem diagnostic evaluations were inconclusive, and diagnosis was finally made from postmortem brain specimens by the use of histologic examination and isolation of the fungus in culture. The portal of entry for the organism was unknown, but the abscesses were confined to the brain alone. P. boydii should be considered as a possible cause of multiple brain abscesses in patients with malignant lymphoma, especially after immunosuppressive treatment with chemotherapy and/or radiotherapy. The literature on the rare occurrence of brain abscesses caused by this fungus is reviewed.
Analysis of observations of 49 patients with rhinosinusogenic brain abscesses revealed differences in their development between adults and children. This pathology occurs in adults more frequently than in children, particularly young children. In adults, brain abscesses usually develop as a result of chronic frontal- or polysinusitis, while in children they typically occur after maxillary sinusitis and in early age children also after acute suppuration in the nasal cavity. For adults, the contact pathway of infection is characteristic, whereas for children, the hematogenic-metastatic pathway is typical. Adults show single abscesses while children show both single, multiple and multichamber abscesses accompanied by separation of cranial sutures, thinning of calvaria, and protrusion and tension of the cranial fontanel. In children, abscesses may grow very large. In adults, the hypertensive syndrome is very distinct, while in children, the hydrocephalic-hypertensive syndrome comes to the foreground. In children, infectious-toxic symptoms are more significant. In adults, focal neurological symptoms become more serious than in children in whom they are also more labile.
A case of brain abscess developing after skull traction for fracture of the dens is presented. The abscess was most likely caused by retrograde septic thrombophlebitis via the superficial cortical veins. The abscess was drained and treatment with antibiotics was according to sensitivity on culture. 3 months after surgery there was mild residual paresis of the left hand. The need for close follow-up of patients prone to this complication is emphasized.
A Blalock-Taussig-anastomosis was performed at the age of 2 years in a boy with transposition of the great arteries, ventricular septal defect, and pulmonary atresia. Nine years later he developed a transient aphasia. Cranial computed tomography (CT-scan) revealed a structure compatible with brain abscess. The boy was conscious and no neurological deficit was found. Initial therapy consisted of Ampicillin, Tobramycin, and Metronidazole, 12 days later an acute hemiplegia developed. 30 ml of pus were aspirated from the brain abscess, and the boy's condition dramatically improved. Streptococcus milleri was found bacteriologically and antibiotic therapy was continued over six weeks. Serial CT-scans during and after therapy demonstrated disappearance of the brain abscess. The presented case shows that after a shunt procedure in cyanotic heart disease right-to-left-shunting and therefore chronic oxygen desaturation and polycythemia are still present as facilitating factors for focal encephalomalacia, cerebritis, and brain abscess. In case of short duration of neurological symptoms and a size of abscess less than 4 cm in diameter antibiotic therapy without total excision may eliminate the infection.
The authors report a case of brain abscess which occurred as a possible complication of a mycotic aneurysm. Inadequate antibiotic treatment given at the time of a febrile illness in a patient with rheumatic heart disease seems to be the most likely cause of this unusual complication. The effects of inadequate antibiotic treatment on the pathogenesis are briefly discussed.
A patient is reported with multiple brain abscesses in whom conservative treatment gave a good result. Attention is called to the small number of such cases described as yet. In accordance with the observations of other authors it is stressed that this treatment is possible only if repeated CT control examinations are available, and only if no raised intracranial pressure is present.
The virulent organism Staphylococcus aureus produced brain abscesses that were quantitatively and qualitatively different from those caused by less virulent organisms. S. aureus abscesses created larger lesions, as earlier ependymitis, delayed progress toward healing, and caused areas of inflammatory escape outside the collagen capsule. Imaging tests revealed similar findings: the abscesses were larger, had more extensive central necrosis, and showed earlier evidence of ependymitis. This virulent organism also demonstrated that white matter is more susceptible than overlying gray matter to destruction by infection. The pattern of spread and other histologic findings suggest that collagen capsule formation has less of an infection "containment" function than was previously thought.
Sixty cases of brain abscesses in patients with cyanotic heart disease is reported. Forty four (73.3%) belonged to pediatric age group. There was only single case of infratentorial abscess located in the cerebellar paravermian region. The abscesses were multiloculated in 42%, multiple in 10% and solitary in 48% cases. Streptococci was the commonest (77%) micro-organism isolated from pus culture. Forty eight patients were treated by aspiration through twist drill, 7 patients conservatively and 5 had primary excision of abscesses. Forty four patients improved in their neurological status, three had fixed neurological deficits and 5 patients deteriorated further. There were 8 deaths. Complication like cyanotic spells was recorded in 17% cases treated by aspiration. None of the patients treated by twist drill aspiration had seizure. It is suggested that aspiration of abscesses through twist drill hole and antibiotic therapy could be the treatment of choice. Vascular slowing in a localised area resulting in infraction and thus preparing the focus for abscess formation is the possible mechanism in the evolution of these abscesses.
Three horses with brain abscesses had different clinical manifestations: 1 had a protracted clinical course whereas 2 had a short clinical course. Clinical signs in 2 horses (1 acute case, 1 chronic case) included unilateral loss of vision, head tilt, circling, abnormal mental status, and ataxia. The 3rd horse had bilateral loss of vision, altered mental status, and apparent deafness. Results of cerebrospinal fluid analysis were inconsistent. The horse with the protracted clinical course had paradoxic central vestibular disease.
A 61-year-old male presented with a brain abscess manifesting as high fever and generalized convulsion attacks. Magnetic resonance (MR) imaging disclosed a ring-like enhanced lesion in the parietal lobe. Thallium-201 single photon emission computed tomography (201Tl SPECT) images demonstrated a high uptake lesion with a 201Tl uptake index on the early image of 2.21, which suggested malignant disease. The washout ratio was 0.73. His symptoms and the ring-like enhanced lesion on MR images disappeared after 2 months of antibiotic treatment. The final diagnosis was brain abscess, despite the 201Tl SPECT findings. 201Tl SPECT washout ratio may be a better indicator of brain abscess than uptake index.
BACKGROUND: Focal intracranial infections caused by Salmonella species are uncommon. The authors report a case of multiple brain abscesses caused by Salmonella typhi. CASE DESCRIPTION: A 2-month-old girl was admitted to the hospital because of diarrhea, vomiting, fever, and poor feeding. Neurological examination revealed cervical hyperextension and absence of sucking and Moro reflexes. During the next 20 hours she developed complex partial seizures with secondary generalization and alternated irritability with drowsiness. Investigation showed hemoglobin 6.3 g/dl; white blood cell count of 19500/mm3 with a marked shift to the left. The analysis of the cerebrospinal fluid revealed white cell count of 1695/mm3, lymphocytes 61%, protein 300 mg/dl and glucose 6 mg/dl. The patient was treated for acute gastroenterocolitis, sepsis, and meningitis. Blood culture taken on the day of admission showed gram-negative bacilli, later identified as S. typhi. Computed tomography scan demonstrated a lesion in the right parietal lobe compatible with a brain abscess. Follow-up computed tomography after 7 days showed several other lesions with the same features. Surgical drainage of the right parietal lesion was performed on the 13th day, through a burr hole. The patient was discharged 5 weeks after admission without neurological deficit. CONCLUSION: Bacteremia, sepsis, and meningitis are relatively common in children with Salmonella infection but intracranial abscesses are very rare. Surgical drainage combined with prolonged antibiotic therapy (drug of choice: chloramphenicol) is the best treatment for Salmonella brain abscesses. The possibility of intracranial infection should be considered in patients with Salmonellosis and neurological dysfunction.
A retrospective evaluation was performed on 28 cases of paediatric brain abscess (male: female ratio 2.5:1; mean age 9.4 years; range 2.8-16 years) diagnosed between 1967 and 1987. In 46%, congenital cyanotic heart disease was identified as a predisposing factor, likewise sinusitis, otitis media or mastoiditis in 29% and immunodeficiency in 11%. Pathogenesis remained unclear in 14%. Initial symptoms and signs were predominantly nonspecific; loss of consciousness occurred in 32% of cases, neurological deficit and seizures each in 25%. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8.4 to 3.0 days, and mortality from 23% to 0%. Seventeen patients (61%) had follow up examinations 9.6 years (mean) after the acute illness (range 1-21 years). Neurological sequelae were diagnosed in 35% of cases, epilepsy in 29%, epileptic potentials during EEG in 12%, and CNS scars in 50%. Psychological testing revealed no statistically significant differences compared to normal populations. CNS scars, and epilepsy and/or epileptic potentials were more common after excision (7 patients) when compared to patients treated by aspiration and/or antibiotics alone (21 patients). It is concluded that excision of brain abscess should be avoided whenever possible. Therapy of choice consists of the administration of adequate antibiotics with or without CT-guided needle aspirations.
Brain abscess evolution was studied in dogs by correlating the CT appearance with the neuropathologic findings. The abscess, produced by direct inoculation, progressed from an area of cerebritis to a well encapsulated abscess over 14 days. Ring enhancement was seen in the cerebritis stage prior to capsule formation. The ring reached its maximum size at this stage and correlated best with the area of cerebritis surrounding the developing necrotic center; the rim of this ring increased in thickness, resulting in progressive diminution of the central lucent area on scans delayed up to 60 min. The diameter of the ring decreased as cerebritis receded. Once the capsule had formed, the central lucent area was similar and no longer filled in on delayed scans.
A case of acute brain abscess in a 59-year-old man is presented. The primary CT findings were misinterpreted as a brain infarct or possibly a tumour. Under steroid therapy an activation of the brain abscess was observed in only nine days and in spite of an immediate operation the patient died.
BACKGROUND: Otogenic complications are rare but typical following acute or chronic ear infections like mastoiditis and cholesteatoma. A life-threatening sequela is the otogenic brain abscess located in the temporal lobe or cerebellum. PATIENTS: At the ENT Department of the Medical University of Hannover/Germany we treated 8 patients suffering from otogenic brain abscesses in the temporal lobe during the last three years. The average age of the 6 male and 2 female patients was 48 years. In 5 patients the abscess developed due to a cholesteatoma with superinfection. Three cases showed acute mastoiditis. All patients were operated using an otosurgical retroauricular approach, in five cases a classical radical mastoidectomy was performed. In two cases the abscess was reached via mastoidal approach and was subsequently drained. In two other cases the abscess was drained some days later by neurosurgical approach due to increased neurological symptoms. The other patients were treated with high-dosed antibiotics under regular clinical and radiological control. RESULTS: In 7 cases complete regression of the abscess was achieved. Five patients were discharged without further otological or central-nervous problems. One female patient developed severe meningitis with generalized thrombosis of the central blood sinus system and died in central circulatory failure. Two other patients developed a moderate psychopathologic syndrome and were admitted to rehabilitation institutions. CONCLUSIONS: The analysis of our patients shows that otogenic brain abscesses should be regarded especially as a severe complication of the untreated cholesteatoma. It is important to use modern imaging modalities like computer tomography or MRI for early detection of the intracerebral lesion and to perform an early otosurgical intervention. Under antibiotics and CT control, healing of this severe complication can be achieved in most cases. However, the danger of acute and chronic ear diseases has to be kept in mind in all medical disciplines.
The consequences of brain abscess (BA) on cognition and behaviour have never been examined in detail. The aim of this study was to determine the long-term cognitive deficits of patients who suffered a BA and to estimate its effect on the quality of life. Twenty patients were included in the study. Follow up with neuropsychological and behavioural tests was performed 6 months to 42 years after BA (mean 10.4 +/- 11.9). Cognitive deficits were defined as a test score of 2 or more standard deviations below controls' mean in those tasks which revealed a significant group deficit. Compared with healthy age, sex and education-matched controls, 13 of 20 patients (65%) exhibited neuropsychological deficits in some cognitive tasks. Ten of those patients (50%) were significantly impaired in < or =2 cognition domains, whilst the remaining three patients (15%) showed three to five impaired domains. No correlation was found between neuropsychological impairments and patients' age, sex, initial neurological symptoms, size and localization of BA, or secondary epileptic seizures. Reduction in quality of life was found in five patients (25%). BA may cause long lasting cognitive deficits. Despite the focal character of the lesion, long-term sequelae follow a more diffuse subcortical deficit pattern.