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[Roentgen study of suspected brain abscess].
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[Radioisotope scintigraphy in the diagnosis of brain abscess].
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Multiple tuberculous brain abscesses in an HIV-infected patient successfully treated with HAART and antituberculous treatment.
Tuberculous brain abscesses (TBA) are an unusual clinical presentation of central nervous system tuberculosis occurring extremely infrequently in developed countries, and almost always in immunocompromised patients. Before the introduction of highly active antiretroviral therapy (HAART), TBA were associated with a high mortality rate in AIDS patients. We describe an HIV-infected patient presenting with multiple TBA who recovered completely with a combination of HAART and anti-tuberculous treatment.
Ramichloridium mackenziei brain abscess: report of two cases and review of the literature.
We report two cases of brain abscesses caused by Ramichloridium mackenziei, a neurotropic dematiaceous fungus that seems to be geographically restricted to the Middle East. One of the patients had chronic myelomonocytic leukemia but did not receive any chemotherapeutic agents. The other patient was a normal host. Both cases had a fatal outcome despite aggressive antifungal therapy and surgical intervention. Herein, we review all previously described cases in the literature, and discuss the epidemiology, mycology and histopathology of this life-threatening organism.
Propionibacterium acnes causes postoperative brain abscesses unassociated with foreign bodies: case reports.
Propionibacterium acnes was isolated in pure culture from brain abscesses that occurred in two patients after intracranial surgery. Although such infections are usually associated with cerebrospinal fluid shunts and other foreign bodies, these cases clearly demonstrate the pathogenicity of this anaerobic diphtheroid in the absence of such. Progression of P. acnes infection in the central nervous system can be insidious. To treat such infections adequately, therapy cannot rely upon some standard antimicrobial agents. Metronidazole, which is useful against most anaerobic organisms, is not effective against P. acnes.
Brain abscess in childhood. A 25-year experience.
The presentation, treatment and outcome of 98 children with brain abscesses at Red Cross War Memorial Children's Hospital, Cape Town, is reviewed. Middle ear disease and trauma were the commonest sources of infection in 60% of patients. The usual presentation was that of meningitis and it is recommended that computed tomography be performed before lumbar puncture in those patients with associated middle ear disease, trauma or sinusitis. With early treatment of both the abscess and the underlying source of infection, the mortality rate was 16%.
[Brain abscess: about a clinical series of 30 patients].
A retrospective study was designed to ascertain the main clinical features of 30 patients admitted for brain abscess between 1989 and 2005. A contiguous source of infection was identified in 40% of cases, direct inoculation secondary to trauma or neurosurgery in 23,3%, and a distant source in 23,3%. Fever, headache and sensorial involvement were the main clinical manifestations. Temporal and frontal lesions were predominant. Microbiological information was available in only half of cases, prevailing polymicrobial and gram-positive bacterial infections. Most patients underwent surgical procedures (66.7%) and the rest received only medical therapy. During antimicrobial treatment, 6 patients (20%) suffered a serious adverse event that prompted discontinuation or change of therapy. Failure of treatment was observed in 40%, including 3 deaths (10%), non-programmed surgical drainage or reintervention (16.7%) and changes of the antimicrobial regimen (13.3%). Eight patients were discharged with sequels (26.7%), and during follow-up, 21% presented major events (death or brain abscess-related readmission).
[Clinical picture of single and multiple rhinogenic brain abscesses].
The authors examined 11 patients with rhinogenous abscesses of the brain aged from 2 to 45, 5 of them with multiple abscesses. According to their data the infection penetrated into the cranial cavity by two principal ways, namely, contactual (in 2 patients) and hematogenous via venous passages (in 4 patients). Contactual cerebral abscesses of rhinogenous genesis more frequently appear during frontitis, have a lingering chronic course and localize at the pole of the frontal lobe. Clinically they manifest themselves by focal and total cerebral symptoms including craniographic changes of hypertensive character. In patients with rhinogenous abscesses of phlebitic genesis a subacute course of the disease was noted. In addition to focal and total cerebral symptoms of general intoxication charater the authors noted in such cases symptoms of depression of the superior truncal structures of the brain. Cerebral abcesses of contactual and phlebitic genesis have mostly a benign course after surgical treatment (out of 6 patients there was only 1 lethal case). Hematogenous spreading of the infection along the arteries is often noted to cause multiple cerebral abscesses (in one or in both lobes) and is frequently accompanied by suppurative meningitis, periventriculitis. All cases of mutiple rhinogenous abscesses had a lethal end.
[Otogenic brain abscess with rupture into the lateral ventricle].
We present a case of otogenic abscess of the brain that ruptured into the ipsilateral cerebral ventricle. All the diagnostic, surgical and postoperative procedures which led not only to saving this patient but also his complete recovery are described. Because there is a great difference between rupture of a cerebral abscess into a ventricle and rupture of the ventricle into an abscess, particularly with reference to the prognosis, the pathology of the two different complications is reviewed, based on the literature.
Stereotactic aspiration of brain abscesses: is this the treatment of choice?
Despite a reduction in the mortality of patients with brain abscess since the introduction of the computed tomography (CT) scanner, controversy persists as to the preferred method of treatment for this condition. Eleven patients were treated by CT guided stereotactic aspiration of pus and appropriate antibiotic therapy. A total of 14 aspirations were performed. Ten abscesses were supratentorial and one was in the posterior fossa. In 9 patients a bacterial cause was identified while in 2 a fungus was identified. A good outcome was achieved in 7 patients but 3 patients died. Another elderly patient remains disabled at home. The deaths occurred in severely systemically ill patients with poor conscious levels on admission. Only one patient has epilepsy, controlled with anticonvulsants while another has not had further seizures since abscess treatment a year ago. Stereotactic aspiration should be considered the treatment of choice in all but the most superficial and largest cerebral abscesses, although the mortality of this condition in the severely ill remains high.
Brain abscess. A study of 45 consecutive cases.
Clinical features, findings of diagnostic studies, results of therapy, and prognostic factors were analyzed in 45 patients with brain abscesses. The number of patients diagnosed yearly has increased since CT scanning became available, but despite the enhanced sensitivity, the time from either onset of symptoms or hospital admission until initiation of therapy was not decreased and there was no dramatic effect upon morbidity or mortality in this series. Infections of paranasal sinuses, ears, lungs, and odontogenic foci were predisposing factors in approximately 70% of cases. Single abscesses, present in 75% of patients, were distributed equally in both hemispheres, with more than half in the frontal and parietal lobes. Common signs and symptoms included headache, fever, chills, seizures, nausea, vomiting, altered sensorium, nuchal rigidity, and localizing neurologic signs. Blood cultures were positive in 11%. Lumbar puncture rarely provided data from which a diagnosis could be established; CSF cultures were positive in only 7% of patients, and there was a 15% temporally associated incidence of brain herniation and death. Diagnostic information was most readily obtained using imaging techniques such as CT and 99mTc scanning, and arteriography was invasive and of no added value. CT scans are however, often initially negative in patients presenting with clinical signs of meningitis presumably following rupture of an abscess into the subarachnoid space, and the average time for changes to appear on CT scan is 9 days. It is, therefore, recommended that when the clinical assessment suggests the possibility of brain abscess the patient be treated empirically with antibiotics and that lumbar puncture be performed only after thoughtful assessment of the risk-to-benefit ratio for each patient. Causative organisms were isolated from more than 80% of abscesses despite prior antibiotic treatment; more than half grew a single pathogen, most commonly streptococci. Anaerobic and microaerophilic bacteria accounted for 62% of all isolates, and were the only organisms in 33% of patients. Computerized tomographic scans in 30 patients showed "ring-enhancing" lesions, nodular enhancement, or areas of low attenuation. Complete resolution of abscesses on CT scans rarely occurred during hospitalization and took as long as 5 months. Decrease in the size of abscesses on CT scan correlated well with clinical improvement and was seen within a week when abscesses were excised, but was often not obvious for 6 to 8 weeks if antibiotics were used alone.(ABSTRACT TRUNCATED AT 400 WORDS)
Tension pneumocephalus in brain abscess after simple puncture-drainage.
A case of tension pneumocephalus within the cavity of a brain abscess after simple puncture-drainage is reported. This possibility has to be taken into consideration when a worsening in the clinical situation of the patient occurs after this procedure.
Brain abscess. Review of 89 cases over a period of 30 years.
Eighty-nine cases of brain abscess, diagnosed over a period of 30 years, are reviewed. The incidence of this disease did not decline throughout the period. Abscesses of ear and nose origin constituted the largest group (38%). Postoperative abscesses seem to have increased in incidence, presumably due to routine postoperative antibiotic treatment. Antibiotics were possibly responsible for the suppression of signs of infection in 45% of the patients, who presented as suffering from a space-occupying lesion. The most accurate diagnostic tool was angiography, which localized the lesion in 90% and suggested its nature in 61%. Brain scan may prove as satisfactory. Staphylococcus was cultured in about two-thirds of the cases. Mortality seemed to decrease concomitantly with the advent of more potent antibiotics. The treatment of choice in terms of both mortality and morbidity seemed to be enucleation after previous sterilization. The hazards of radical surgery should be taken into consideration.
The evolution of a brain abscess the complementary roles of radionuclide (RN) and computed tomography (CT) scans.
Serial Tc-99m glucoheptonate brain scans demonstrated a brain abscess in a patient from the earliest phase of acute focal encephalitis (cerebritis) through the capsule formation and the recovery phase. The role of the RN and CT scans in the diagnosis of the early stage of cerebritis and the complementary nature of RN and CT scans in intracranial infections, particularly abscesses, are discussed. Guidelines for the use of RN and CT scans are suggested.
Multiple brain abscesses: treatment by a conservative approach--a case report.
A 57-year-old male with six brain abscesses was successfully treated with metronidazole and ampicillin under close CT-control. To exclude possible tuberculosis a cortical abscess was excised for culture and microscopy. Hydrocephalus which developed was drained and subsequently treated with a permanent ventriculo-peritoneal shunt. Within 42 weeks the remaining five abscesses all showed complete resolution on the CT-scan.
Fungal brain abscesses in leukemia.
Invasive fungal infections remain a life threatening complication in children with hematological malignancies. The brain represents a common site of hematogenously disseminated infections from an extracranial focus. We report our experience in the diagnosis, radiological aspects and therapeutic approach of fungal brain abscesses in 2 children receiving chemotherapy for acute lymphoblastic leukemia (ALL).