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PubMed1976

Brain abscess and congenital heart disease.

The clinical features and management of 18 patients with congenital heart disease and a brain abscess are reviewed. Except for one patient all had cyanosis. All abscesses were large, containing at least 50-60 ml of pus, and mostly unilocular. Bilocular and multilocular abscesses were also encountered. The organisms cultured from the pus had little relation to the mortality. Tapping may be the final investigation, and is also the treatment of choice. The high mortality (50%) is attributed to the delay in referral of these patients to a neurosurgical unit.

Adolescent↗
PubMed1986

Bilateral brain abscesses complicating the use of Crutchfield tongs.

The case of a 4-year-old girl who developed bilateral brain abscesses complicating skull traction is reported. Crutchfield tongs were used to reduce a fracture dislocation at C2-3. Presenting symptoms consisted of headaches and focal seizures. Surgical treatment and antibiotics using serial CT led to a satisfactory outcome. This is the first reported case of this complication in a child. The current literature is reviewed.

Brain Abscess↗
PubMed1985

[Hyperbaric oxygen therapy of anaerobic brain abscesses following tonsillectomy].

This study describes the clinical course of a 31 year old woman who developed multiple anaerobic brain abscesses six days after tonsillectomy, followed by hemoparesis and dysarthria. In spite of craniotomy, repeated punctures and drainage of pus and high dose local and systemic antibiotics, there was an obvious deterioration in the patient's condition. Hyperbaric oxygen therapy was tried as a last resort. The patient improved quickly, and six months after the tonsillectomy seems to be neurologically symptomfree.

Adult↗
PubMed1991

[Differential diagnosis of rhinosinusogenic cerebral leptomeningitis and brain abscesses].

Analysis is made of the results of examination of 247 patients with cerebral leptomeningitis and 49 patients with brain abscesses. Owing to a comprehensive examination of that patients' group by means of a number of the current research methods, the immunocytochemical, roentgeno-radiological++ (computer-aided tomographic, MR tomographic, gamma-topographic) signs typical of each form of intracranial complications were delimited. This enables an early clinico-nosological + diagnosis to be established, which is of paramount practical importance for the choice of the appropriate treatment policy.

Adolescent↗
PubMed1992

Management of brain abscess in children: review of 130 cases over a period of 21 years.

The data on 130 children with brain abscesses treated over 21 years (1970-1990) were analyzed retrospectively. The whole group included four infants. Chronic ear infection and cyanotic congenital heart disease were the most common predisposing factors. In infants, meningitis and/or ventriculitis were dominant in the etiopathogenesis. Cases were evaluated according to the treatment received and also according to time periods. More than half of the patients (n = 74) in this series were treated by primary or secondary excision. Computed tomography (CT) facilitated the diagnosis and helped the planning of treatment. Aspiration gained increasing credit after the advent of CT. Microorganisms could be identified in 54% of the cultured specimens. Staphylococci, streptococci and Proteus were the dominating microorganisms. Penicillin and chloramphenicol have long been the mainstay of antimicrobial therapy but have recently been replaced by third-generation cephalosporins and sulbactam-ampicillin combinations. Overall mortality was 15.5% but showed a decline from 30% in the pre-CT era to 6% in the last 5 years and to zero in the last three. Neither the location nor associated heart disease contributed to the mortality, but mortality among infants was as high as 50%.

Adolescent↗
PubMed1997

[Single stage excision for an intractable brain abscess and free rectus abdominis flap for reconstruction of the anterior skull base].

A case is presented of the frontal brain abscess following resection of squamous cell carcinoma of the maxillary sinus who had undergone reconstruction of the anterior skull base using a free rectus abdominis muscle flap. Local flap, ex. galeal flap, can be used for separating the cranial space from the paranasal sinuses and the nasopharynx, but it cannot provide reliable separation and protection of the brain from bacterial flora of the upper airway and it is too weak to support the brain in cases where orbital exenteration has been performed. The distant flaps such as the pectoralis major musculocutaneous flap, on the other hand, can provide a good alternative for reconstruction of the anterior skull base in such difficult cases, but frequently requires a secondary division of the pedicle. The free flap can circumvent such problems. We used the free rectus abdominis muscle flap and the postoperative course was uneventful. A bone graft was not necessary to reconstruct the anterior skull base.

Brain Abscess↗
PubMed2005

An essential role for tumor necrosis factor in the formation of experimental murine Staphylococcus aureus-induced brain abscess and clearance.

Tumor necrosis factor-alpha (TNF-alpha) is a central mediator of the immune response to pathogens, but may also exert neurotoxic effects, thereby contributing to immunopathology. To define the role of TNF during the course of brain abscess, TNF-deficient (TNF(0/0) mice were stereotaxically infected with Staphylococcus (S.) aureus-laden agarose beads. In comparison to 100% survival of wild type (WT) mice, TNF(0/0) mice displayed high mortality rates (54%) in the initial phase of abscess development as well as significantly increased morbidity in the course of the disease. The worse clinical outcome was due to an increased intracerebral (i.c.) bacterial load in TNF(0/0) mice as compared to WT mice. The impaired control of S. aureus was associated with reduced inductible nitric oxide synthase (iNOS) mRNA and protein expression in TNF(0/0)mice. Similarly, numbers of inflammatory leukocytes, cytokine expression of IL-6, IL-12p40, IFNgamma IL-beta mRNA, and brain edema were significantly increased in TNF(0/0)mice as compared to WT animals. In addition, resolution of i.c. infiltrates was delayed in TNF(0/0)mice correlating with reduced apoptosis of inflammatory leukocytes and formation of a fibrous abscess capsule. Collectively, these data demonstrate that TNF is of key importance for the control of S. aureus-induced brain abscess and regulates the ensuing host immune response.

Animals↗
PubMed1983

Brain abscess due to penicillin- and clindamycin-resistant Bacteroides melaninogenicus.

The case of a patient with severe anaerobic infection, a brain abscess, is presented. The causative organism was a penicillinase-producing, clindamycin-resistant strain of Bacteroides melaninogenicus. Treatment with adequate doses of penicillin G failed. Findings in this case suggest caution when basing therapy on the untested assumption that B. melaninogenicus is routinely susceptible to penicillin and clindamycin therapy.

Adult↗
PubMed1997

[A case of pulmonary arteriovenous fistula presenting as multiple brain abscesses after a sustained period without treatment].

A 64-year-old man was admitted to our hospital with multiple brain abscesses accompanied by pulmonary arteriovenous fistula (PAVF). He had been diagnosed with PAVF eight years previously, but had refused any treatment despite a developing exertional dyspnea. Rendu-Osler-Weber disease was diagnosed as well because the patient exhibited teleangiectasis of the nasopharyngeal mucosa and persistent gastro-intestinal bleeding. Despite administration of antibiotics and corticosteroids the abscesses perforated into the lateral ventricle. The natural history of this rare disease is still incompletely understood. Thus, the time at which treatment should be commenced remains unclear. However the natural course of PAVF is unsatisfactory, and it appears that treatment by surgery and/or embolization should be considered in all cases.

Arteriovenous Fistula↗
PubMed1985

Large Cryptococcus neoformans isolated from brain abscess.

Cryptococcus neoformans yeast cells 40 to 60 micron in diameter were seen in an India ink preparation made from a human brain abscess specimen. In culture at 25 degrees C, uniform 5-micron-diameter yeast cells were produced. Inoculation into mice produced yeast cells up to 40 micron in diameter, and brain heart infusion broth culture at 35 degrees C produced yeast cells about 25 micron in diameter. A relationship of yeast cell diameter to incubation temperature is suggested.

Adult↗
PubMed2002

Brain abscess complicating cerebral infarct.

PRESENTATION: We report a case of a 68-year-old man who suffered ischemic strokes in the left middle cerebral artery territory and three months later, following urosepsis, developed a cerebral abscess in the infarcted area. DISCUSSION: A literature search found only eight other cases. We discuss herein the common clinical aspects of brain abscess complicating strokes, the co-existent diseases, and point out the possibility of underreporting this rare but treatable complication. CONCLUSION: Cerebral abscess should be suspected in patients with a previous brain infarction or haemorrhage, who develop bacteremia and impaired consciousness without a clear explanation to their condition. Advanced age, and medical conditions known adversely to affect immunological competence reinforce the clinical suspicion.

Aged↗
PubMed2000

Brain abscess caused by methicillin-resistant Staphylococcus aureus.

A Swedish tourist was admitted to a Cuban hospital due to epileptic seizures caused by brain tumors. Upon return to Sweden and admission to our hospital, methicillin-resistant Staphylococcus aureus (MRSA) was isolated. He was later considered to be free of MRSA but then developed a brain abscess from which MRSA was isolated.

Brain Abscess↗
PubMed1994

Aspergillus brain abscess in a patient with normal immunity--case report.

A 53-year-old male with normal immunity presented with Aspergillus brain abscess manifesting as frontal headache. T2-weighted magnetic resonance imaging revealed a hypointense lesion in the left frontal lobe extending into the right frontal lobe. The hypointense appearance on T2-weighted images appears to be characteristic of aspergillosis. Bifrontal craniotomy exposed an elastic-hard mass in the base of the left frontal lobe extending into the right frontal lobe, and into the left ethmoid sinus. The mass contained a cavity with white fluid. The abscess was removed almost totally. The histological diagnosis was Aspergillus abscess. Antibiotic treatment with amphotericin B and fluconazole was given for 2 months postoperatively. No recurrence was identified during 15-month follow-up.

Amphotericin B↗
PubMed1988

Melioidosis with brain abscess.

Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.

Acute Disease↗
PubMed1987

Value of the ring-enhancing sign in differentiating intracerebral hematomas and brain abscesses.

Computerized tomography (CT) is a sensitive method for detecting intracerebral pathology. Ring enhancement on contrast CT scan is a classic finding for intracerebral abscesses. Two cases are described in which clinical and physical findings were not suggestive of brain abscess; however, CT scan disclosed ring-enhancing lesions. Both patients were found to have vascular abnormalities without evidence of infection. The diagnostic dilemmas and specificity of ring enhancement on contrast CT scan are discussed.

Adult↗