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We report the rare occurrence of a pyogenic brain abscess at the site of a preceding intracerebral haemorrhage in a 58-year-old man. The diagnosis was based on clinical observations, isolation of Staphylococcus aureus from blood cultures, and characteristic cerebrospinal fluid and cerebral computed tomography findings. The patient had a favourable response to antibiotic therapy.
Results are submitted of surgical treatment of 64 patients with multiple abscesses of the brain. The greatest benefit appeared to be from a combined treatment option involving different combinations of operative intervention (puncture, drainage, and complete removal) and, against this background, adequate doses of antibacterial agents. Overall fifty three patients (82.8%) underwent surgical treatment. Of these, 39.6 percent had their abscesses removed. Aspiration + drainage (22.6% of cases), aspiration + removal (16.9%) came in the second and third place respectively. Total mortality was 42.1%, operative mortality 35.7%. The lowest mortality level (16.6%) appeared to be in the combination of abscess puncture + drainage + removal. In the second place there came to be removal (death rate 28.7%) followed by the combination of puncture + removal (death rate 33.3%). Late operative intervention carried out in the patients during the stage of decompensation together with inadequate method of treatment were by far the commonest causes of the recorded mortality rates.
An experimental cerebral abscess model in which alpha-hemolytic Streptococci were inoculated into the brain parenchyma of dogs was evaluated for assessment of antimicrobial therapy. Intracerebral ring-enhancing lesions were visualized by computerized tomography, but they resolved after time without therapeutic intervention. Histopathological study demonstrated evolution of the lesions into sterile granulomas. Quantitative cultures were performed and uniformly became sterile in the early cerebritis stage, approximately 3 days after bacterial inoculation. Therefore, this brain abscess model should not be utilized for the evaluation of new antimicrobial treatment regimens. Rather, other models which document persistent viable organisms within cerebral abscesses need to be developed.
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We describe a case of a 25-year-old female with an acute left otomastoiditis, accompanied by a left temporal extradural abscess with moderate perifocal edema and meningitis. Intravenous meropenem (2 g 8-hourly) and intravenous methylprednisolone (40 mg once daily) were commenced empirically. Teicoplanin (400 mg once daily intravenously) was added after 5 days when culture results were available. Teicoplanin was discontinued on day 25 but meropenem and methylprednisolone were continued for a further 15 days, after which the abscess completely resolved without sequelae. No treatment-induced adverse effects or seizures were observed. Thus, in selected patients, antibacterials (in conjunction with a corticosteroid) may be successfully used without surgery to treat brain abscesses and in such circumstances meropenem is a useful option for empiric therapy.
Four patients with clinical findings and computerized tomographic brain scan evidence of brain suppurative disease were treated and cured with high-dose intravenous antibiotics without neurosurgical intervention. More data are required before any statement can be made regarding the long-term efficacy of nonsurgical versus surgical management of brain abscess.
The authors report 80 cases of collected cranio-encephalic suppurations observed in the Neuro Surgical Unit of the University Teaching Hospital of Dakar from 1969 til 1990. 13 cases were necropsy discoveries and 67 cas that were operated consisted of 55 abscesses of the brain and 25 extra-cerebral empyemas. 56 patients were under 20 years of age with an obvious prevalence of male patients. The collected cranio-encephalic suppuration complicated head trauma in 22 cases and was consecutive to an otorhinolaryngeal infection in 10 cases. The typical clinical aspect of progressive installation associated an intracranial hypertension, motor deficit of one side of the body and an epileptic crisis. A brutal beginning was not an exception in 16 cases. This is often in subdural empyemas. Concerning neuroradiology, cerebral angiography still constitutes our method of choice of investigation; echography can only be performed in infants with permeable fontanela, or during post operative surveillance, using the lacuna created by the craniotomy as an acoustic window. Simple puncture and drainage of the cerebral abscess of the classical cutting away in bloc and the utilisation of echography have considerably contributed for the amelioration of post-operative results.
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Multiple brain and liver abscesses developed immediately after Bacillus cereus bacteremia in a neutropenic patient with acute lymphoblastic leukemia. After even 8 weeks of antimicrobial chemotherapy together with administration of granulocyte colony-stimulating factor, every infectious process disappeared but the patient's headache has still persisted. Because the wall of one brain abscess became thin and was in danger of rupturing into the ventricle, surgical drainage was performed, resulting in disappearance of headache and resolution of brain abscess. The present case indicates that a combined medical and surgical approach is mandatory to treat patients with brain abscesses.
A report is given of effective non-surgical treatment with antibiotics in a patient with a large brain abscess.Non-surgical treatment of brain abscesses may be possible if massive doses of specific bactericidal antibiotics are used and the patients are followed up with frequent brain scans and computerized tomography.
Meningitis is rarely seen following oral injury. We describe a 3-year-old boy developing meningitis and brain abscess following a penetrating oral wooden stick injury. There was no cerebrospinal fluid rhinorrhea noted. A cerebrospinal fluid culture yielded viridans streptococcus. Brain magnetic resonance imaging and computed tomography revealed a multiloculated ring-enhancing mass. This patient underwent surgical drainage and completed 8-week antibiotic therapy. The patient demonstrated a late and dismal complication of a penetrating oral injury. At 2-year follow-up the patient was in good condition. A penetrating oral wooden stick inury should be regarded as potentially serious.
The history and findings in a patient with erythroleukaemia who developed a fungal brain abscess during the agranulocytic phase of induction treatment is reported. The radiological features of fungal infection are reported, with emphasis on the importance of clinical judgement in making the diagnosis. The autopsy findings further illustrate the increasing importance of this previously very rare condition.
In this study pus samples obtained during operation from 28 patients with brain abscess have been examined microbiologically. In three of the 28 patients the cultures were negative (10%) obligate anaerobic bacteria from 20 (80%) patients, microaerophilic bacteria from 2 (4%) patients, aerobic bacteria from 11 (44%) patients have been isolated. Among the 15 obligate bacteria and 2 microaerophilic bacteria, the highest resistance has been shown against tetracycline, among the 11 aerobic bacteria the highest resistance has been shown against Gentamicin and Tetracycline.
No deaths have occurred among 20 consecutive patients with intraparenchyma brain abscesses treated at the University of California, San Francisco, since computerized tomographic (CT) brain scanning became a routine diagnostic procedure (study period: July, 1974, to June, 1977). These patients have been compared to 18 consecutive cases treated without benefit of CT analysis (January, 1970, to June, 1974) in order to determine the factors responsible for the recently improved prognosis. The mortality rate was 44% for all cases and 36% for all operated patients treated before the availability of CT. Similar morbidity (about 33%) was seen in survivors from both series. No significant differences in the two groups were noted with respect to patient population and antibiotic or corticosteroid therapy. Among the factors that may have contributed to the improved results for patients diagnosed with CT are: less frequent occurrence of multiple abscesses, fewer patients with poor preoperative clinical status, and a greater incidence of total abscess removal. In addition, CT scanning provided more accurate diagnosis and localization of abscesses and aided in the rapid detection of postoperative complications that probably accounted for six out of eight deaths in the earlier series. Serial CT studies provide a means to optimize the timing for surgical intervention and plan appropriate medical therapy. It is noteworthy that two patients have been followed by serial CT scans to non-surgical cures.
We report the occurrence of a Pasteurella multocida temporal lobe abscess in an elderly woman who had a history of neglected chronic purulent otitis and in whom an extensive ipsilateral glomus tumour invading the petrous bone was found. We believe this is the first report in the literature of an otogenic cerebral abscess associated with a glomus jugulare tumour and the fifth report of a Pasteurella multocida brain abscess. The synergistic pathogenesis of the otitis and the glomus tumour in the evolution of the abscess is hypothesized.
Complete recovery from deep brain abscesses was achieved in four patients treated by a specialized stereotactic method. In one patient the lesion was in the right thalamus, in two patients within the brain stem and in one case in the right rolandic cortex. The technique consists in the stereotactic implantation of a chronic intracavitary catheter connected to a subcutaneous reservoir to allow postoperative multiple evacuations and local antibiotic irrigations. Serial CT scan examinations guided the timing of intracavitary treatment and the removal of the catheter. No recurrence developed. The diagnostic and therapeutic advantages of this stereotactic technique are emphasized.
The authors report on a case of hydrocephalus caused by brain abscess in a four-months-old girl. After repeated punctures and antibiotics administration extirpation of abscess was necessary. The child recovered with only slight neurological deficit.
Twenty-eight patients of cyanotic congenital heart disease (CHD) complicated with brain abscess were reviewed. There were 22 males and 6 females with a mean age of 9.1 +/- 5.5 years. Tetralogy of Fallot was the commonest cyanotic CHD observed. Transposition of great arteries (PS), tricuspid atresia with VSD, PS and double outlet right ventricle with VSD comprised 25% of the cardiac lesions. Febrile illness was the commonest mode of presentation (42.86%). Frontal lobe was the commonest site of abscess localization (37.5%) followed by parietal lobe (32.5%). Multiple abscess were seen in 32.14% and in 35.7% the pus was sterile on culture. Twelve patients died (mortality -42.8%), and autopsy reports were available in 6. Infective endocarditis was suspected in 7 on clinical grounds, while at autopsy, out of 6 only 2 had evidence of right-sided endocarditis. There was no correlation of mortality with age, sex, type of micro-organism, site of abscess localization and the nature of heart disease. Multiple abscesses, features of raised intracranial tension and associated meningitis/ventriculitis predicted a grim outcome.