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PubMed1993

Penetration of intravenous antibiotics into brain abscesses.

INTRA-ABSCESS CONCENTRATIONS OF the intravenously administered latamoxef (LMOX, moxalactam in the United States) and cefotetan (CTT), were studied in 11 patients with intracranial abscess. None of these patients underwent surgical ablation of the abscess. In all cases, the abscess was aspirated, and multiple aspirations were required in five patients. Antibiotic concentrations in 18 aspirates were, therefore, determined by the agar well method. LMOX concentrations in 16 aspirates drawn from nine brain abscess cases ranged from 0 to 10.9 micrograms/ml, with a mean (standard deviation) of 4.18 (3.04) micrograms/ml. The CTT concentration in one patient with a brain abscess was 8.51 micrograms/ml, and the LMOX concentration in the one remaining patient with subdural empyema was 5.20 micrograms/ml. In one patient, the serum-to-pus penetration rate of LMOX was estimated to be 0.11 against the peak value of the concentration in serum or 0.44 against the simultaneously obtained level in serum. Significantly higher concentrations of LMOX were produced in abscess cavities with multiple-dose administration or by prior drainage of pus. More-advanced stages of local inflammation, as demonstrated by computed tomography, correlated with higher concentrations. However, the routine indexes of systemic inflammation, such as body temperature, white blood cell count, and level of C-reactive protein in serum, cannot be used to predict the concentration present in intracerebral pus. A tendency for LMOX concentrations in pus obtained after single dose-administration to decrease with increasing duration from symptom onset to sampling was observed but was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Anaerobic bacterial meningitis with multiple brain abscesses].

The improvement of bacteriological techniques for isolation and identification of anaerobes has led to an increased interest in anaerobic infections. However, anaerobes have only rarely been found in cases of purulent meningitis, representing less than 1 percent of all isolated pathogens. We observed anaerobic meningitis in a patient suffering from multiple lung abscesses from which anaerobic bacteria spread to the brain, causing formation of anaerobic brain abscesses and consecutive meningitis. Microbiological examinations for anaerobes should be performed in those cases of meningitis in which purulent infections of other organs with known or suspected anaerobic etiology are present or in which a traumatic lesion of the subarachnoid space has preceded the development of meningitis.

Adult↗
PubMed1985

Diagnosis of brain abscesses with indium-111-labeled leukocytes.

Sixteen patients with intracerebral mass lesions where computed tomography (CT) was not fully conclusive with respect to the differential diagnosis between brain tumor and abscess were examined with leukocyte brain scintigraphy (LBS). Autologous leukocytes were labeled with indium-111 oxinate and were reinjected intravenously; registration with a gamma camera was performed after 24 and 48 hours. In 10 of 11 patients with the final diagnosis of a brain tumor, no accumulation of radiolabeled leukocytes could be detected in the brain. In 4 of 5 patients with the final diagnosis of brain abscess, scintigraphy showed a pronounced increase of focal activity corresponding to the lesion demonstrated with CT. The reasons for the one false-positive and the one false-negative result are discussed, and it is concluded that LBS (a) can be used to detect intracranial infection and (b) may be a useful diagnostic tool for distinguishing between brain abscess and brain tumor.

Adult↗
PubMed1997

Brain abscess in renal transplant recipients: report of three cases.

BACKGROUND: Neurologic complications occur in about 30% of renal transplant patients, infections being the most common. We encountered three such patients and present our experience in the management of such cases. CLINICAL MATERIAL: Three cases of brain abscess in renal transplant recipients are reported. These patients presented from 9-60 months after the transplant. One patient had a pyogenic abscess; in the second the organism identified was Nocardia asteroides; in the third, a fungal infection was responsible. In two patients excision of the abscess was done, while in one repeated aspirations with intracavitary antibiotics were used. All received systemic antimicrobial therapy. CONCLUSIONS: Central nervous system (CNS) complications, specifically infections, are quite common in renal transplant recipients, but reports of brain abscesses in these patients are very rare. The treatment options for such patients are discussed.

Adult↗
PubMed1979

Cystic fibrosis with brain abscess.

A 21-year-old patient with cystic fibrosis developed bilateral brain abscesses due to anaerobic Streptococcus. This rare association presents an interesting etiologic study.

Adult↗
PubMed1989

[2 cases of brain abscess as a complication of direct cranial traction].

Two cases of brain abscess as a complication of direct cranial traction have been presented. In the first case traction was used in the treatment of aneurysmatic cyst of the cervical spine, in the second case for cervical spine trauma. In the first case development of abscess was related with local infection in the site of localization of traction, and in the second case, most probably, with direct contamination of the brain tissue in the site of dura mater perforation. In both cases abscess was treated surgically; in the first case, a female patient was discharged with severe neurological deficit and in the second case, the male patient recovered without neurological deficit.

Adult↗
PubMed1991

Meningioma presenting at a site of a previously aspirated brain abscess.

We report the case of a meningioma which developed in the parieto-occipital lobe at the site where a brain abscess had been aspirated 9 years previously. There was no history of head trauma. To the best of our knowledge this is the first reported case of a meningioma associated and possibly aetiologically related to a previous inflammatory process in the absence of head trauma. The association of chronic inflammation and the subsequent development of a meningioma is discussed.

Brain Abscess↗
PubMed1996

Stereotactic aspiration and drainage of brain abscesses. Experience with 9 cases.

The first-line treatment for brain abscesses is still a much-debated argument. Recently, stereotactic aspiration of these lesions has gained ground as a valid alternative to the traditional medical and/or surgical therapeutical treatments. From 1991 to 1995, 9 patients affected by intracranial abscesses were surgically treated by stereotactic puncture of the lesion and drainage of pus, using the Kelly-Goerss stereotactic system. Multiple abscesses were present in one case. Specific antibiotic therapy was used in the post-operative stage, when possible. One death occurred four weeks after surgery for acute ischemia of the brain stem. Follow-up CT demonstrated gradual resolution of the abscesses in all the cases and a successful return to normal daily life in all the surviving patients. In one case, recurrence of the abscess occurred two months after resolution: a successful result was obtained by steroids and broad-spectrum antibiotic therapy alone. Possible advantages of this technique are discussed and compared with the traditional routes. The literature concerning this argument is reviewed.

Adolescent↗
PubMed1987

Brain abscess of odontogenic origin: report of case.

Advanced dental infection rarely causes brain abscess resulting in death. Good dental hygiene and removing abscessed teeth are advised for prevention of any such occurrence. An intercranial infection is described in a 29-year-old male who also had a dental phobia.

Adult↗
PubMed1981

Brain abscess: a review of 400 cases.

The author reviews 400 cases of brain abscess treated in China over 20 years. The commonest cause was chronic ear infection, with abscesses in the temporal lobe and cerebellum. Signs of increased intracranial pressure were present in most cases, localizing neurological signs in two-thirds, and clinical signs of infection in only 57%. The difficulties of early diagnosis may be considerable. Definitive diagnosis was dictated by the techniques available: when clinical features and ultrasound indicated a localized abscess, a burr hole and exploratory aspiration were used; otherwise, and in complicated cases, angiography or ventriculography were required. Antibiotics were given in full doses for an extended period. Aspiration was the initial treatment in 253 cases, with 22% mortality. Excision was the sole treatment in 128 patients, of whom 17.2% died. A further 76 patients underwent aspiration followed by excision; 25% of these patients died. There was no significant difference in mortality in these treatment groups. The most important predictor of outcome was the patient's condition when first seen. In 103 cases, signs of brain herniation were present; the mortality was 64% in these patients. In the 297 without herniation, mortality was only 8.4%. Early referral for specialist care, computerized tomography, correct choice and dosage of antibiotics, and the surgical methods in present use should make this a benign disease.

Anti-Bacterial Agents↗
PubMed2000

Otogenic brain abscess: review of 41 cases.

Forty-one patients in whom otogenic brain abscess was diagnosed and has been treated since 1968 are presented. Sixty-five percent of the patients were between 5 and 15 years of age. All patients had chronic otitis media, and 95% had cholesteatoma. Abscess was located in the temporal lobe in 54%, in the cerebellum in 44%, and in both locations in 2% of the cases. Most patients had radical mastoidectomy and evacuation of the abscess through the mastoidectomy (61%). In addition to mastoidectomy, burr hole drainage was used in 20% and craniotomy in 15%. The most common micro-organism involved was Proteus. Overall mortality in this series is 29%, but after 1976, when CT became available for the diagnosis and follow-up, the mortality rate was reduced to 10%.

Adolescent↗
PubMed1982

Near-drowning complicated by brain abscess due to Petriellidium boydii.

Extracutaneous infection from Petriellidium boydii is an unusual occurrence despite the ubiquity of the organism in nature. Central nervous system infection by this organism is extremely rare, only seven previous reports having been found. The rarity of this manifestation prompted the report of a brain abscess occurring in a previously healthy youth after a near-drowning. The source of the infection was likely to have been the river water at the accident site, from which P boydii was isolated. Although previous in vitro susceptibility data and failure of amphotericin B therapy in a similar infection suggested miconazole treatment might be beneficial, the organism causing the brain abscess was resistant to miconazole and amphotericin B. This report emphasizes the urgent need for safer and more predictably effective alternatives to currently available antifungal agents.

Adult↗
PubMed2025

Robot-Assisted Stereotactic Aspiration of a Parietal Brain Abscess With Metagenomic Identification of Fusobacterium nucleatum.

Robot-assisted stereotactic aspiration offers a minimally invasive approach to brain abscesses near the eloquent cortex. We report a rare case of a left parietal abscess caused by Fusobacterium nucleatum in an immunocompetent adult, managed successfully with this approach. The patient, a 52-year-old man, presented with right-sided limb numbness. MRI and contrast-enhanced CT revealed a cystic, ring-enhancing lesion with diffusion restriction in the left parietal lobe. Despite empiric broad-spectrum antibiotics, neurological deterioration occurred due to progressive mass effect. Robot-assisted stereotactic aspiration enabled single-stage, precise drainage of the abscess. Metagenomic next-generation sequencing identified F. nucleatum , prompting adjustment of antibiotics to ceftriaxone plus metronidazole, followed by metronidazole monotherapy. The patient improved clinically, and a 6-month MRI confirmed complete resolution, underscoring the precision of robotic stereotaxy for eloquent-region abscesses and highlighting the diagnostic value of metagenomic sequencing in detecting anaerobic pathogens.

Humans↗
PubMed1997

[Packing drainage of transmastoid approach for treatment of otogenic brain abscess: a report of 30 cases].

Thirty cases of patients with otogenic brain abscess (OBA) who received mastoid radical operations were treated simultaneously by means of packing drainage via the appoach of the mastoid operative cavity. 26 cases of those were cured. The results showed that the therapeutical method gave satisfactory effectiveness and had many advantages. It provided an effective montitor for retraction and had many vomica, and gave ample drainage for retraction in that it made OBA seldom recur. The operative procedure is fit for the great majority of OBA. The paper also discussed intraoperative and postoperative complications and other problems pertinent to the operation.

Adolescent↗