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PubMed2000

Brain abscess formation in radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma.

BACKGROUND: Radiation necrosis is a known complication following radiation therapy for extracranial as well as intracranial tumours. However, brain abscess formation in radiation necrosis has not been reported in the literature. We report the clinical data of 6 patients suffering from this condition. METHOD: Twenty-eight patients with radiation necrosis of the temporal lobe following radiotherapy for nasopharyngeal carcinoma were treated surgically at the Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong between January 1992 and July 1999. Of these, 6 cases were complicated by brain abscess formation. The clinical data of these 6 patients are retrospectively reviewed. FINDINGS: The patients were 5 males and 1 female, ranging in age from 41 to 67 years. Three patients had previous treatment with steroids for the symptomatic radiation necrosis. A history of nasal infection or otitis media was recognised in all 6 patients. All patients were treated surgically by temporal lobectomy and excision of the necrotic tissue together with the abscess cavity. Intra-operatively, a bony defect was observed between the middle cranial fossa and the sphenoid sinus in 3 patients and the bony defect was repaired with a temporalis muscle flap. The species of organisms could only be identified in 3 patients. In 3 patients, the pus smear was positive but the culture was negative. Subsequently, 4 patients recovered and 2 patients died. INTERPRETATION: Cerebral radiation necrosis is a predisposing cause of brain abscess formation. Surgical excision is recommended as the treatment of choice in this group of patients.

Adult↗
PubMed1998

Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses.

OBJECTIVE: In vivo proton magnetic resonance spectroscopy was performed for 24 patients with pyogenic brain abscesses, to examine the consistency of the spectral patterns and to observe the changes in metabolites with treatment. METHODS: Localized proton spectra were obtained from 4- to 8-ml volumes in the abscesses, using stimulated echo acquisition mode and spin echo sequences. Twenty-two patients were treated with combined surgical and medical therapy, and two patients were treated conservatively. High-resolution magnetic resonance spectroscopy was performed for 15 samples of abscesses obtained from these patients, to confirm the assignments of resonances seen in vivo. Postaspiration studies were performed for 12 patients treated with combined medical and surgical therapy and 2 patients treated medically. RESULTS: Lactate and amino acids were seen in spectra for all patients, irrespective of the time of spectroscopy after the onset of combined medical and surgical therapy. Acetate and pyruvate disappeared after 1 week of combined treatment. CONCLUSION: It was concluded that spectral patterns for brain abscesses are consistent and specific and can assist in the noninvasive diagnosis of abscesses. Responses to combined treatment could be monitored by showing the changes in metabolite patterns in serial spectroscopic studies.

Adolescent↗
PubMed1995

Brain abscess due to Bacillus macerans following a penetrating periorbital injury.

We report a case of a brain abscess due to Bacillus macerans and Clostridium sp. following a penetrating periorbital injury by a wooden branch. Intracranial penetration by and retention of a foreign body were not suspected initially, and neurological symptoms developed only 2.5 months later. Previously reported cases of brain abscesses due to Bacillus species are reviewed.

Bacillaceae Infections↗
PubMed1985

[Brain abscess in a bidirectional atrial septal defect in adulthood].

An abscess of the brain is a serious complication in patients with congenital heart malformation. The great majority of cases are limited to cyanotic congenital heart disease and a peak in the age distribution can be seen in childhood. We report on a 40-year-old man with progressive right hemiparesis due to an abscess in the left basal ganglia. Clinical aspects and additional diagnostic assessment are described. By cardiologic examination including transoesophageal cross-sectional echocardiography a bidirectional sinus-venosus defect could be detected. This finding supported the diagnosis of a so-called 'paradoxical' brain abscess.

Adult↗
PubMed2001

Fungal brain abscesses in neonates: Sonographic appearances and corresponding histopathologic findings.

Extremely preterm neonates and neonates with predisposing conditions such as congenital or acquired immunodeficiency are at high risk for systemic fungal infection. Abscess formation in the brain is a severe complication that occurs in 70% of neonates with systemic fungal infection. Cerebral sonography can be used to diagnose abscesses in the brain in these patients. We report 2 sonographic presentations of fungal brain abscesses in neonates confirmed by postmortem histopathologic examination. The first patient, an extremely preterm neonate of 23 weeks' gestation with a systemic Candida albicans infection, had multiple small, round, hypoechoic lesions with echogenic rims in both brain hemispheres. The second patient, a term neonate with disseminated aspergillosis and DiGeorge syndrome, had a few large echogenic areas in the right periventricular region. Brain imaging should be considered in the diagnostic workup in neonates with suspected systemic fungal infection. Cerebral involvement can be diagnosed at the bedside with cerebral sonography.

Aspergillosis↗
PubMed1981

Gas-containing brain abscess due to Fusobacterium nucleatum.

Gas-containing brain abscesses are rarely seen. Recently, in a 28-year-old man, such an abscess ruptured into the lateral ventricle but was treated successfully. Fusobacterium nucleatum, an anaerobic bacillus, was cultured from the pus obtained.

Adult↗
PubMed2005

Traumatic cholesteatoma presenting as a brain abscess: a case report.

OBJECTIVE: To discuss the clinical aspects and management of traumatic cholesteatomas of the temporal bone. STUDY DESIGN: Case report. SETTING: University hospital, tertiary referral center. PATIENT, INTERVENTION, AND RESULTS: The authors describe an uncommon case of otogenic brain abscess resulting from an infected cholesteatoma arising from an old temporal bone fracture line involving the external auditory canal in an otherwise healthy 21-year-old man. The patient was successfully treated with brain abscess drainage, tympanomastoidectomy, and broad-spectrum intravenous antibiotic therapy. CONCLUSIONS: The authors recommend long-term follow-up in any patient with a longitudinal or mixed temporal bone fracture with low threshold for obtaining temporal bone computer tomography imaging for any new otologic complaints. Traumatic cholesteatomas complicated by brain abscess should be treated with broad-spectrum intravenous antibiotic therapy and aggressive surgical intervention.

Adult↗
PubMed2003

Aetiological diagnosis of brain abscesses and spinal infections: application of broad range bacterial polymerase chain reaction analysis.

OBJECTIVE: To evaluate the usefulness of the broad range bacterial rDNA polymerase chain reaction (PCR) method combined with DNA sequencing in the aetiological diagnosis of intracranial or spinal infections in neurosurgical patients. METHODS: In addition to conventional methods, the broad range bacterial PCR approach was applied to examine pus or tissue specimens from cerebral or spinal lesions in patients treated in a neurosurgical unit for a clinical or neuroradiological suspicion of bacterial brain abscess or spondylitis. RESULTS: Among the 44 patients with intracranial or spinal lesions, the final diagnosis suggested bacterial disease in 25 patients, among whom the aetiological agent was identified in 17. A causative bacterial species was identified only by the rDNA PCR method in six cases, by both the PCR methodology and bacterial culture in six cases, and by bacterial culture alone in five. All samples in which a bacterial aetiology was identified only by the PCR approach were taken during antimicrobial treatment, and in three patients the method yielded the diagnosis even after >/= 12 days of parenteral treatment. One case also identified by the PCR approach alone involved a brain abscess caused by Mycoplasma hominis, which is not readily cultured by routine methods. CONCLUSIONS: In patients with brain abscesses and spinal infections, the broad range bacterial rDNA PCR approach may be the only method to provide an aetiological diagnosis when the patient is receiving antimicrobial treatment, or when the causative agent is fastidious.

Anti-Infective Agents↗
PubMed1983

Brain abscess in childhood. A study of 34 cases treated by puncture and antibiotics.

During the last 15 years, 34 children were treated for a brain abscess. 13 (38%) had cyanotic heart disease; 12 (35%) had an ENT infection. The standardized treatment protocol included puncture of the abscess and administration of antibiotic and antiedematous drugs. Postoperative permanent epidural monitoring of intracranial pressure and, in the last 5 years, repeated CT scans indicated if retapping the abscess or reinforcing the antiedematous treatment was necessary. In 7 out of these 34 cases the abscess had to be excised. Postoperative mortality rate was 6%. Overall mortality rate was 12%. Neurological sequelae were slight. Epilepsy frequency was 10%. Mental retardation (18%) was found only in cyanotic congenital heart disease to which it is related. Repeated CT scans demonstrated the progressive disappearance of the capsule within a few months. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.

Adolescent↗
PubMedDate not supplied

Multiple brain abscesses and bacteremia in a child due to Fusobacterium necrophorum.

A case of Fusobacterium necrophorum bacteremia and multiple brain abscesses in a 6-year-old child following a Mycoplasma pneumoniae infection is described. Brain abscess due to this microorganism has only been described in three other cases since 1977. The clinical picture was consistent with postanginal septicemia, with septic metastatic complications normally only seen in teenagers and young adults. The patient was successfully treated with a 2-month course of parenteral penicillin G and metronidazole.

Bacteremia↗
PubMed2006

Piperacillin/tazobactam in treatment of brain abscess.

Central nervous system (CNS) infection is a common complication following renal transplantation. Successful management of a brain abscess usually requires a combination of antibiotics and surgical drainage for both diagnostic and therapeutic purposes. We report the successful treatment of a patient with multiple brain abscesses with piperacillin/tazobactam without surgical intervention.

Anti-Bacterial Agents↗
PubMed1987

Brain abscess with hemorrhage.

A very rare case of brain abscess with hemorrhage in the basal ganglia is reported. We discuss the difficulties in the differential diagnosis and the mechanism of hemorrhage.

Adult↗
PubMed2005

Brain abscess due to Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans, a constituent of the oral flora, is a rare cause of brain abscesses. We report the case of a 47-year-old male who presented with multiple brain abscesses due to this organism, presumably originating from his poor dentition. Problems met in isolating and identifying A. actinomycetemcomitans suggest that its true rate of isolation from non-oral samples may have been underestimated.

Actinobacillus Infections↗
PubMed2005

Brain abscesses--the Groote Schuur experience, 1993-2003.

OBJECTIVE: To review management and outcome of patients with brain abscess treated at Groote Schuur Hospital (GSH) between 1993 and 2003. PATIENTS AND METHODS: Case notes, radiological results and laboratory records were reviewed retrospectively for 121 patients at GSH who underwent a neurosurgical procedure for treatment of a brain abscess between 1993 and 2003. Patients not treated surgically were excluded. Follow-up with serial computed tomography (CT) scans, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels and the temperature chart were used to determine the duration of parenteral antibiotic treatment and the need for repeat surgical evacuation of pus by either aspiration or excision of the capsule. RESULTS: The mean patient age was 33 years, with a male-to-female ratio of 5:1. Headache, depressed level of consciousness and pyrexia were the commonest presenting symptoms. Other symptoms included seizures and hemiparesis. The frontal lobe was the commonest site (44%); the majority of abscesses occurred as a result of infection following trauma. Mastoiditis (21%) and sinusitis (8%) were the second and third most common causes. Organisms were identified in 81% of cases; polymicrobial infections occurred in half of these. Thirty-three different organisms were identified, the majority of which were Gram-positive bacteria. Anaerobes were present in 23%, while methicillin-resistant Staphylococcus aureus was identified in 1 patient. Nocardia was seen in 3 patients, 2 of whom were diabetic. The average duration of parenteral antibiotic therapy was 15 and 19 days for excision and aspiration respectively. Accurate ESR records were available in 75% of cases, with a positive predictive value in 81%, while CRP (in use since 1999) was helpful in 92% of cases. OUTCOME: Sixteen patients (13%) died, 12 of whom had been admitted with a Glasgow Coma Score (GCS) of less than 4T/15. Thirteen patients developed epilepsy. On discharge, patients continued to take oral antibiotics for another 4 weeks, at the end of which they were reviewed at the neurosurgery outpatient department. CONCLUSION: Compared with previous studies from this hospital, mortality and morbidity have been diminishing progressively. GCS at the time of admission remains the most important prognostic factor.

Adult↗
PubMed1987

Listeria brain abscess associated with steroid therapy: successful non-surgical treatment.

A patient is reported who developed a brain abscess due to Listeria monocytogenes while on long-term steroid therapy and who was successfully treated medically without surgical intervention. The literature on listeria brain abscess is reviewed, and the importance of early recognition of this infection in any immunocompromised patient who develops focal cerebral dysfunction is emphasised.

Adult↗
PubMed1984

[Proteus mirabilis brain abscess in a neonate].

A case of neonatal brain abscess was reported. This female infant was born by spontaneous vertex delivery at 38 weeks gestation, weighing 3.1 kg. There were no antenatal and perinatal complications. The Apgar's score was 8 points and her head was 32.8 cm in circumference. Fifty-six hours after birth, she had a clonic general convulsion for about 3 minutes. On the next morning, convulsion recurred, and she was transferred to our hospital. When admitted to the Pediatrics, she was exhausted and irritable. But after hospitalization, she improved without convulsions. CT scan, performed 7 days after birth, revealed large low density areas in both frontal lobes. Electroencephalography showed spike discharge at all leads. The head circumference gradually increased and subsequent CT scans revealed enlargement of the bifrontal low density areas. The first operation was done 28 days after birth. A large amount of yellowish grey pus was aspirated from both sides and the cavity was irrigated. Tobramycin was administered into the abscess cavity. Culture of the pus grew proteus mirabilis. The postoperative conditions were good. But two weeks later her head started to enlarge with the bulging fontanelle. CT scan revealed marked dilation of the ventricles and enlargement of the left frontal abscess. At 2 months of age, second operation was done. Left frontal abscess was punctured and serous pus was aspirated. Proteus mirabilis was cultured again from the pus. Tobramycin was administered into the cavity via the drainage tube every day for a week. As the content of the abscess cavity became clear, V-P shunt and cyst-peritoneal shunt were performed. After shunting procedure, the increase of head circumference stopped and the fontanelle became flat and soft.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Abscess↗
PubMed1992

Brain abscess: a rare complication of halo usage.

The halo traction device for cervical spine immobilization has few complications and is routinely used for spinal cord injured patients. The following case report describes a patient with lower cervical and upper thoracic fractures stabilized with a halo. She completed a two-month rehabilitation program without complications, but developed frontal headaches and vomiting within one or two days of discharge. A head CT revealed a right frontal isodense mass consistent with a brain abscess. The abscess was resected surgically, and she was placed on antibiotics. Mortality rates from brain abscesses are as high as 24%, making a prompt diagnosis critical. This case report describes an unusual etiology for a brain abscess, and it discusses the appropriate work-up in a neurologically impaired patient.

Adolescent↗