Aphasia as a symptom of otogenic brain abscess.
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Aphasia↗
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[Diagnostic significance of plasma cells in the cerebrospinal fluid, special reference to their demonstration in brain abscess].
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Adult↗
Listeria brain abscess, Pneumocystis pneumonia and Kaposi's sarcoma after temozolomide.
BACKGROUND: A 55-year-old man with glioblastoma multiforme was treated with continuous, dose-dense temozolomide. This therapy was curtailed after three cycles because of nausea, asthenia, and neuropsychological deterioration. During a subsequent course of radiotherapy, the patient developed fever, headaches, and cutaneous lesions. INVESTIGATIONS: Physical examination, cerebral MRI, brain biopsy, skin biopsy, immunohistochemistry, bronchoscopy with bronchoalveolar lavage, and laboratory tests. DIAGNOSIS: Severe temozolomide-induced immunosuppression, exacerbated by corticosteroids, with profound T-cell lymphocytopenia and simultaneous opportunistic infections with Pneumocystis jiroveci pneumonia, brain abscess with Listeria monocytogenes, and cutaneous Kaposi's sarcoma. MANAGEMENT: Discontinuation of temozolomide, discontinuation of radiotherapy, antibiotic treatment with amoxicillin and gentamicin, and administration of atovaquone and pentamidine.
Antineoplastic Agents, Alkylating↗
Pefloxacin-induced arthropathy in an adolescent with brain abscess.
We present a case of pefloxacin-induced arthropathy in a 15-year-old patient with brain abscess. Six joints were involved, of which the right elbow joint was most severely affected. Magnetic resonance imaging of the right elbow revealed joint effusion, and bone scintigraphy showed increased tracer uptake which was still present in the follow-up bone scans.
Adolescent↗
The management of brain abscess in a developing country: are the results any different?
A retrospective study of 57 surgically-managed brain abscesses at the Neurosurgical Unit, Bir Hospital during a 6-year period from October 1990 is presented. Detailed hospital case notes could be traced in only 37 cases, consisting of 25 males and 12 females with age range from 5 months to 60 years. Cryptogenic abscess was the commonest category followed by abscess caused by chronic ear infection. The diagnosis was made with enhanced computed tomography (CT) in all the cases. Positive bacteriology was found in only nine cases. The treatment consisted of 6 weeks of intensive intravenous antibiotics and emergency surgical drainage of the abscess. Five out of the total cases died (13.5%). These patients were all in an extremely poor condition at the time of presentation. All the survivors made a good recovery. With timely CT diagnosis, surgical drainage and antibiotics, good results can be achieved even in a developing country.
Adolescent↗
[Brain abscess: successful treatment of 4 cases including one with ventricular perforation].
The authors experienced with four cases of brain abscess, one of which ruptured into the lateral ventricle. Two cases were treated conservatively and the remaining two were treated surgically. All cases recovered satisfactorily. Case 1: A 30-year-old man with congenital cyanotic heart disease was admitted on Oct. 4, 1979, because of convulsion. Physical examination revealed motor aphasia, right hemihypesthesia, cyanosis, clubbed finger and continuous heart murmur. CT scan showed a ring-enhance mass lesion in the left temporal lobe. Although transient deterioration of the clinical course was observed, he improved satisfactorily after medical treatment of 20 days. Case 2: A 54-year-old man with left homonymous upper quadrantanopia and systolic heart murmur was admitted on Sept. 17, 1979. alpha-streptococcus was detected in the culture of his arterial blood. Vegetation near the mitral valve was revealed by ultrasonic cardiogram. CT scan showed an irregular and ill-shaped ring-enhanced mass in the left temporoparietal region. A saccular aneurysm in the insular portion of the posterior parietal artery was seen on the left carotid angiogram. He was also treated medically and the abscess was gradually reduced and the aneurysm disappeared. Case 3: A 28-year-old man complaining of headache, nausea and vomiting was admitted on Dec. 1, 1979. Physical examination revealed nuchal stiffness, right homonymous hemianopia and bilateral choked disc.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Sinogenic and otogenic brain abscesses--a review of 63 cases occurring at Toronto General Hospital, 1956-75.
Sixty-three cases of brain abscess resulting from ear and paranasal sinus infections were reviewed. These patients were seen at the Toronto General Hospital from 1956-1965 and from 1969-1975. Comparisons are made relating to site, age and sex incidence, mortality rates, bacteriology, and rate of associated meningitis. Modern diagnostic methods are reviewed with particular emphasis on the use of the C.T. scanner.
Adolescent↗
Nocardiosis with brain abscess due to an unusual species, Nocardia transvalensis.
The identification of Nocardia transvalensis, an unusual and probably underrecognized cause of nocardial infection, is clinically significant because of this species' resistance to aminoglycosides, a standard antinocardial therapy. Diagnosis requires analytic methods available predominately in reference laboratories. We report a case of disseminated infection with N transvalensis with primary pulmonary involvement and subsequent development of brain abscesses, and review the literature to date. Familiarity with the epidemiology, pathologic findings, and clinical significance of this and other unusual Nocardia species may increase early identification and antibiotic susceptibility testing in cases of nocardial infection.
Aminoglycosides↗
Factors associated with mortality in brain abscess.
Coma on admission, multiple, deep, or ruptured abscess, inaccurate diagnosis, and inability to prove the diagnosis were factors contributing to mortality. In survivors, abscess generally followed cranial injury, surgery, or contiguous infection; in most fatal cases, brain abscess was secondary to a more remote primary infection. Ruptured or multiple abscesses or positive spinal fluid cultures were not found in survivors, and coma was present in only one. Fatal cases in patients admitted in coma usually did not exhibit focal signs, seizures, or symptoms of meningitis early in the illness; none of these patients had prior cranial injury or surgery. Absence of these delayed their seeking care and accurate diagnosis. Ruptured abscess was frequent in these patients. Most patients not in coma on admission had focal signs, seizures, symptoms or meningitis, or had prior cranial injury or surgery.
Adolescent↗
Brain abscess in which Porphyromonas gingivalis was detected in cerebrospinal fluid.
In this paper, we report one case of severe brain abscess in which Porphyromonas gingivalis was detected in the spinal fluid.
Bacteroidaceae Infections↗
Non-surgical treatment of the solitary brain abscess in children.
In a ten year old girl with operated congenital heart defect: pulmonary stenosis, a solitary brain abscess developed in the right frontotemporal region after teeth extraction. The clinical disease was manifested with fever, headache and by tonic epileptic seizure of the grand mal type dominating on the left side. Suspicion of the abscess existence has been raised on the basis of the EEG finding and proved by the brain CT scan. Agent has not been identified, most probably due to antibiotic therapy applied prior to admission. We decided for the antibiotic treatment with benzilpencillin (500,000/kg/day), chloramphenicol (50 mg/kg/day) cloxacillin (130 mg/kg/day) intravenously during 4 weeks. Clinical improvement of the condition, the EEG and CT findings occurred two weeks after the beginning of the therapy. After a month further marked improvement of the EEG findings occurred as well as the disappearance of the abscess cavity. Three months after the completed therapy the control EEG and the brain CT scan were normal. The girl having been followed up for three years is growing normal and has completely normal neurologic findings.
Anti-Bacterial Agents↗
Brain abscesses and ischemic necrotic lesions during early childhood.
The cases of seven children, all under 6 months of age, with cerebral abscesses are presented. In four cases, there was previous meningitis; the others presented with expanding mass lesions. The infectious agent was Proteus in four cases and Escherichia coli and Citrobacter in one each; in another patient, no agent was isolated. In six children, there were multiple areas of ischemic necrosis. In one instance, these areas were in the hemisphere contralateral to the purulent collection. The peculiar clinical, diagnostic, and therapeutic aspects of brain abscesses in this age group are discussed.
Anti-Bacterial Agents↗
Fatal Klebsiella pneumoniae meningitis and emphysematous brain abscess after endoscopic variceal ligation in a patient with liver cirrhosis and diabetes mellitus.
Procedure-related bacterial infections may complicate esophageal variceal ligation in cirrhosis patients. Here, we report a 58-year-old man with underlying diabetes and liver cirrhosis who developed Klebsiella pneumoniae meningitis and brain abscess with gas formation in brain parenchyma and ventricles after this procedure. Despite administration of appropriate antimicrobial therapy, he became comatose on the 3rd day of acute illness and died on the 4th day of hospitalization. This case highlights the indication for antimicrobial prophylaxis in cirrhotic patients with gastrointestinal bleeding, and the need for early and heightened awareness of central nervous system infections in cirrhotic patients with hepatic encephalopathy.
Brain Abscess↗
The physiopathogenetic basis for the angiographic diagnosis of bacterial infections of the brain and its coverings in children. II. Cerebritis and brain abscess.
Most of the small (50--60 micrometers) vessels nourish exclusively the cerebral cortex, whereas larger caliber (80--150 micrometers) arteries penetrate the entirety of the cortical layer to enter the underlying white matter. A single layer of nonfenestrated endothelial cells, surrounded by a continuous layer of basement membrane (which in places splits to envelope a pericyte), and perivascular glial cells attached to the outer surface of this basement membrane, with no pericapillary space, represent the anatomical structure of the blood-brain barrier (BBB). Concentrated electrolyte solutions and increases in mean arterial pressure may reopen the BBB. Water-soluble contrast media used in cerebral angiography are hypertonic solutions of iodinated salts. In cerebritis, one observes a very typical angiographic picture: 'laminar' staining of the gyri. The intervening sulci appear as negative images. In brain abscess, one may note angiographic evidence of a space-occupying lesion, a capsular stain in the granulation tissue surrounding the abscess, 'halo' formation and 'pooling' of contrast media in the sulci, and 'laminar' staining of the gyri.
Bacterial Infections↗
Brain abscess related to metal fragments 47 years after head injury. Case report.
The authors report a case of symptomatic brain abscess in a 51-year-old man who presented with personality changes and generalized seizures. He had survived a grenade explosion injury during the Korean War 47 years previously. Computerized tomography scanning revealed multiple conglomerate rim-enhancing lesions and metallic foreign bodies in the right frontal lobe. The mass was totally removed and Pseudomonas aeruginosa was isolated from microbial cultures. Retained foreign bodies in the brain, whether bone or metal, should be removed at the time of injury if at all possible. If this cannot be accomplished, patients with such retained foreign bodies should be carefully monitored for life.
Brain Abscess↗
Successful outcome of aspergillus brain abscess in a patient who underwent bone marrow transplantation for aplastic anemia.
We report the course of an aspergillus brain abscess in an 18-year-old female patient who underwent bone marrow transplantation for aplastic anemia. The abscess was discovered on day 35 post-transplant, in a cranial computerized tomography (CT) scan performed for the evaluation of an unexplained headache. Meanwhile, she was receiving broad-spectrum antibacterials and liposomal amphotericin B for a right upper pulmonary lobe infiltrate. A percutaneous puncture of the cerebral lesion was performed; fungal elements were seen in the pus obtained and its culture yielded A. fumigatus. The dose of amphotericin B was increased, intraconazole was added and two more punctures were done. With these antifungals, the abscess regressed significantly; so, amphotericin B was discontinued after a cumulative dose of 6775 mg but intraconazole was maintained at 400 mg/day. At the last follow-up, seventeen months after detection of the abscess, the patient was well, without symptoms and the cerebral lesion diminished to a very small, thick-walled CT image.
Adolescent↗
[Systemic administration of antibiotics in therapy of brain abscesses. Present trends and possibilities].
The authors describe possibilities as regards selection of antibiotics in the general treatment of brain abscesses. They mention the most frequent aetiological agents of the disease in relation to predisposing factors and site. Systemic antibiotherapy along with surgery is considered by the authors decisive in the therapy of these conditions.
Anti-Bacterial Agents↗
Potential role of human brain microvascular endothelial cells in the pathogenesis of brain abscess: inhibition of Staphylococcus aureus by activation of indoleamine 2,3-dioxygenase.
Cerebral abscess is a rare complication of staphylococcal septicemia in infants associated with high mortality and morbidity. In the pathogenesis of abscess formation, S. aureus, one major causative agent, interacts with endothelial cells of the brain vessels before reaching the central nervous system. This study examined the growth of S. aureus in human brain microvascular endothelial cells (HBMEC) cultures stimulated with cytokines. IFN-gamma inhibited S. aureus replication by the induction of indoleamine 2,3-dioxygenase (IDO) in HBMEC. This activation of IDO in HBMEC could be shown by RT-PCR and by detection of kynurenine in culture supernatants of activated cells. Resupplementation of L-tryptophan abrogated the inhibitory effect of IFN-gamma on the growth of staphylococci, hence confirming the activation of indoleamine 2,3-dioxygenase as being responsible for the induced bacteriostasis. Addition of TNF-alpha enhanced the IFN-gamma mediated antibacterial effects, whereas TNF-alpha alone had no influence on staphylococcal growth. Stimulation of HBMEC with IFN-gamma failed to activate inducible nitric oxide synthase (iNOS) and subsequent production of nitric oxide (NO). Thus, intra- and extracellular depletion of L-tryptophan seems to be an important process in the defense against staphylococcal brain abscesses by means of creating an unfavorable microenvironment.
Brain Abscess↗