[ATTEMPTED CLASSIFICATION OF OTOGENIC BRAIN ABSCESSES].
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Brain Abscess↗
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[Multiple Aspergillus brain abscesses complicated by bronchial asthma].
A 35-year-old man was hospitalized for the treatment of severe asthma attack. His condition improved with intensive steroid chemotherapy under artificial ventilation. On the 12th hospital day, he was taken off respirator support but lost consciousness afterward. Computed tomography of the brain disclosed multiple hypodense lesions with bleeding. T1-weighted magnetic resonance imaging disclosed low-intensity lesions containing high-intensity areas. T2-weighted images showed heterogeneous high-intensity lesions. The autopsy specimen demonstrated multiple brain abscesses. Histologic examination revealed branching fungal hyphae in abscess walls and also extending through arterial walls with emboli. These findings yielded a diagnosis of multiple Aspergillus infarct abscesses of the brain.
Adult↗
High-resolution ultrasound evaluation of experimental brain abscess evolution: comparison with computed tomography and neuropathology.
Computed tomographic (CT) and high-resolution ultrasound (HRUS) imaging of experimental brain abscess were correlated with neuropathologic findings in nine mongrel dogs. The HRUS scan was more sensitive to different histologic features than the CT scan but both accurately delineated the evolution of the experimental brain abscess. All stages of abscess evolution were characterized by an appearance of an echogenic rim with a hypoechoic center. In the early stages the echogenicity of the abscess was related primarily to marked cellular infiltration, while in the late stages extensive collagen deposition correlated closely with the echo pattern. The size of the abscess in the cerebritis stages appeared smaller on the HRUS scan than on the CT scan because the latter modality detected the extensive cerebritis around the developing necrotic center whereas the HRUS scan did not. This discrepancy disappeared in the capsule stages. The HRUS scan provided a more accurate depiction of the neuropathologic characteristics of the necrotic than did the CT scan. Healing of the abscess, indicated by a decrease in size of the hypoechoic center, was accurately detected by the HRUS scan.
Animals↗
Anaerobic bacteria in brain abscess, a review; observation of 18 consecutive cases.
The aerobic and anaerobic bacterial flora of 18 consecutive cases of brain abscesses were studied. Two cases were sterile. In five cases there was a single bacterial isolate. In five cases there was a single bacterial isolate the organism being Staphylococcus aureus in two cases, Bacteroides fragilis in two cases and Peptostreptococcus anaerobius in one case. In the remaining eleven cases, more than one organism was isolated. A combination of anaerobe with an aerobe was observed in five cases and infections with more than one anaerobe in as many as six cases. Anaerobic organisms are the important pathogens in brain abscess and occurrence of infections by more than one organism is a common factor.
Adolescent↗
Nonsurgical cure of brain abscess in a neonate.
A 7-day-old girl was found to have meningitis due to Staphylococcus aureus and a left parietal brain abscess. Six weeks treatment with intravenous methicillin resulted in resolution of her right hemiparesis and brain abscess. This is one of the youngest patients successfully treated by medical therapy alone. The case suggests that in carefully selected, closely monitored infants, medical therapy alone can be successful.
Brain Abscess↗
Nocardial brain abscess in a renal transplant recipient successfully treated with triple antimicrobials.
Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.
Amikacin↗
Are dental infections a cause of brain abscess? Case report and review of the literature.
Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.
Brain Abscess↗
Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.
We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.
Adult↗
Brain abscess due to Nocardia asteroides. Report of a case.
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Abscess↗
Brain abscess following insertion of skull traction.
A case of brain abscess developing 2 weeks after insertion of skull tongs is reported. The abscess was treated with aspiration and appropriate antibiotic therapy and its complete resolution was confirmed by CT scan. The pathogenesis, through retrograde spread of superficial infection to durocortical veins, is discussed in the light of serial CT scans at different stages of formation and treatment of the abscess.
Adult↗
Pathogenesis of brain abscess formation in an infant rat model of Citrobacter diversus bacteremia and meningitis.
The pathogenesis of Citrobacter diversus meningitis and brain abscess was studied in infant rats. Two-day-old rats were inoculated intraperitoneally and intranasally with C. diversus. C. diversus strain 4277, lacking the 32,000-molecular-weight outer membrane protein that appears to be a marker for strains causing meningitis in human neonates, was more likely to produce bacteremia, meningitis, and death in rats than was strain 4036, which possesses this outer membrane protein. Strain 4036 was, however, more likely than strain 4277 to produce ventriculitis and brain abscess. In the infant rat, central nervous system involvement by C. diversus begins with bacteremia and leptomeningitis, followed by ventriculitis and direct extension of infection into periventricular brain parenchyma. Large numbers of bacteria persist inside inflammatory cells, an observation suggesting resistance to intraphagocytic killing. Bacterial strain differences, possibly related to the presence of a 32,000-molecular-weight outer membrane protein, may account for histopathologic differences in the brains of infant rats with C. diversus meningitis.
Animals↗
Intraventricular haemorrhage complicating a brain abscess.
Intraventricular haemorrhage occurred in a patient with a parietal rim-enhancing mass on computed tomographic scan. At operation a brain abscess was identified and removed. Peptostreptococcus and fusobacterium were isolated, possibly of dental origin. The possible sources of this intracranial bleeding are discussed. A neoplasm should not always be considered in the case of a cerebral ring-enhancing mass complicated with intracranial bleeding; in selected cases, brain abscess should be excluded too.
Brain↗
Computed tomography and mortality rate in brain abscess.
A small series of eleven consecutive cases of brain abscess, with one death, is presented. Early diagnosis and accurate localisation by computed tomography (ct) are emphasized and the clinical features discussed.
Adolescent↗
Dental implications of brain abscess in children with congenital heart disease. Case report and review of the literature.
There is a high morbidity and mortality associated with brain abscesses in children with congenital cyanotic heart disease. A case is reported here which implicated an endodontically treated primary molar in the etiology of a brain abscess in a boy with congenital cyanotic heart disease.
Brain Abscess↗
Evaluation of treatment effects in brain abscess with positron emission tomography: comparison of fluorine-18-fluorodeoxyglucose and carbon-11-methionine.
Positron emission tomography (PET) imaging is in common use preoperatively to clinically evaluate patients who present with central nervous system mass lesions. The usefulness of PET is also recognized as a method to detect intracranial tumorous lesions. A number of papers reportthat some inflammatory processes also showed the uptake of Fluorine-18-Fluorodeoxyglucose (FDG) and Carbon-11-Methionine (Met) tracers. We performed two PET studies before and after treatment in 4 patients with brain abscess. PET showed the uptake of both tracers to thebrain abscess before treatment. The area showing an increased uptake of Met corresponded closely to the enhanced area on both CT and MR images. FDG-PET visually showed an uptake of FDG in a small area corresponding to an enhanced lesion within the CT and MR images. After treatment the area of lesions became small on enhancement CT or MRI and both PET studies showed reduced lesion and decreased uptake. The mechanism of Met uptake in the inflammatory area may be related to the higher metabolic rate and the active transport of amino acids as well as disruption of the blood brain barrier. Furthermore, it appears that the mechanism of FDG uptake is also related to a higher metabolic rate and, in addition, is related to the increased density of inflammatory cells. PET studies, more directly, reflect the degree of inflammatory response in brain abscess than enhancement CT or MRI. Therefore, PET is useful in detecting the inflammatory lesion and assessing the clinical effects of antibiotics treatment on brain abscesses.
Adult↗
Citrobacter diversus ventriculitis and brain abscesses in an adult.
A case of Citrobacter diversus brain abscesses following urinary infection in an adult is described. The patient was treated with surgical drainage, netilmicin and cefotaxime. Citrobacter species CNS infection is discussed.
Aged↗
[Otogenic brain abscesses in children].
In the years 1953-1989 in the Department of Otolaryngology, Medical Academy in Poznań 75 patients were treated for otogenic brain abscesses, among them 19 were children. In the last ten years the number of cases of this complication was not increased significantly in children and adults. In 3 cases abscess was diagnosed in acute otitis media, in the remaining cases it was a complication of chronic otitis media with cholesteatoma. Brain abscesses were situated more frequently in the temporal lobe. In children they developed more frequently on the right side. The survival in temporal lobe abscesses in children was 90%, and in cerebellar abscesses 75%. In adults the survival rate was about 80% for both localizations. In the treatment of these otogenic complications wide radical operation on the middle ear or ++antro-mastoidectomy with exposure of the dura and simultaneous approach to the abscess from the postoperative ear cavity, with puncture of the abscess and replacement of its contents with normal saline with antibiotic is the routine method in the Department.
Adolescent↗
Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years.
The records of 102 patients with brain abscesses treated over 17 years were analyzed. In recent years, cardiac and pulmonary causes were less frequent, the abscesses were smaller, and fewer patients were in poor neurological condition. There has been no significant change in the type or number of infective organisms or in the number of abscesses during the study period. Computed tomographic brain scanning was the most important factor in reducing the mortality rate from 41% to 4%. The patients were grouped according to the treatment received: excision (n = 46), aspiration (n = 33), or nonsurgical therapy (n = 17). Patients treated nonsurgically were more likely to have smaller abscesses and multiple lesions than were patients in the other two groups. There were no significant differences in the morbidity or mortality rates between treatment groups. Patients whose abscesses were excised had a significantly shorter course of antibiotics than the other patients. Organisms were identified in 85% of the cultures from surgical specimens. The use of preoperative antibiotics was significantly associated with sterile cultures; 30% of patients who received antibiotics preoperatively had sterile cultures, compared with only 4% of patients who did not receive such treatment. The mortality rate among all treated patients (the diagnosis of brain abscess was missed in 6 patients before computed tomographic scanning became routine) was significantly related to the initial neurological grade and the size of the lesion but not to age, sex, or the number of abscesses. Four of the 8 treated patients who died had congenital cyanotic heart disease; an aggressive surgical approach is recommended for such patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗