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Cryptogenic brain abscess.
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Clinical analysis and results of operative treatment of 41 brain abscesses.
In this study, 41 cases of cerebral abscess operated on in our clinics between 1977 and 1986 were investigated retrospectively. The surgical strategy and the factors affecting the mortality rate were discussed. It was confirmed that the most important factor affecting the mortality rate was the consciousness level of patients in the preoperative period. The importance of computed tomography (CT) for early diagnosis and management of brain abscess is stressed.
Endoscopic treatment of brain abscess in children.
Three children with intracerebral abscesses were treated endoscopically. Two of the treated abscesses were located in the left temporal lobe and one in the right parietal lobe. The presenting symptoms included headaches, seizures, hemiparesis and signs of infection. Burr hole craniotomy, insertion of a peelaway sheath, obtaining of a specimen, introduction of endoscope, and complete irrigation under view was performed. After this a draining catheter was positioned in the abscess. All three abscesses grew multiple organisms. The patients received longstanding intravenous treatment with antibiotics. The follow-up period in this group ranges between 5 and 32 months. The initial neurological deficits were relieved in all three patients. The follow-up MRI studies revealed minor residual changes without evidence of significant sequelae. Neuroendoscopic treatment of brain abscesses has additional advantages compared to stereotactic aspiration or more complete drainage and lavage.
Necrotizing otitis externa, otitis media, peripheral facial paralysis, and brain abscess in a thalassemic child after allogeneic BMT.
Severe infection is one of the major complications in the early and late post-bone marrow transplantation period. The authors report a thalassemic child who developed necrotizing otitis externa and otitis media, a very rare complication after bone marrow transplantation, and then peripheral facial nerve paralysis and brain abscess in the early period of bone marrow transplantation despite antibacterial and antifungal prophylaxis. Necrotizing otitis media is characterized by necrosis and sloughing of considerable areas in the middle ear and adjacent tissues and is an unusual disorder because of today's antibiotics. Granulocytopenia and background ear tissue exposed to previous repeated otitis media attacks may be the predisposing factors in this case. The authors conclude that the children with previous histories of recurrent otitis media should be prepared and monitored very carefully during bone marrow transplantation because of the risk of necrotizing otitis media, especially in the granulocytopenic period.
Infectious endocarditis associated with subarachnoid hemorrhage, subdural hematoma and multiple brain abscesses.
Hemorrhagic stroke is a complication of infectious endocarditis (IE), and severe hemorrhage accompanies Staphylococcus aureus IE during early uncontrolled infection. However, subarachnoid hemorrhage (SAH) or subdural hematoma is rare. A case of S. aureus IE associated with SAH and subdural hematoma in the early stage is reported. A 54-year-old man with a history of mitral valve prolapse presented with fever. Two days after the onset, he fell into a confused state with convulsion and left hemiparesis. He became comatose and brain CT and MRI demonstrated SAH and subdural hematoma with severe right hemisphere swelling. Multiple brain abscesses were also observed. No septic aneurysm was detected by cerebral angiography.
A case of brain abscess as complication of esophageal dilation for caustic stenosis.
The authors report a case of a two-year-old child with esophageal stricture -- caused first by caustic ingestion and by the end-to-end anastomosis, performed after the excision of the stenotic esophageal segment-- that required repeated dilations. These manouvres unfortunately led to bacteremia and a serious complication of a brain abscess, in the right fronto-parietal area, that was promptly removed. A few months later the child was subjected to an esophageal substitution with a colonic transposition. At present he is in good condition and the follow-up showed normal function of the neo-esophagus.
[Diagnosis and surgical treatment of brain abscess in infants and children].
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[BRAIN ABSCESS AND MENINGEAL SYNDROME].
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Successful non-surgical treatment of brain abscess and necrotizing fasciitis caused by Bacillus cereus.
Musculoskeletal and central nervous system infections caused by Bacillus cereus are very rare. Only a few cases have been reported, whose clinical courses strongly suggested that surgical procedures combined with appropriate antimicrobial therapy are necessary to cure these infections. A 60-year-old man with severe neutropenia due to myelodysplastic syndrome, developing necrotizing fasciitis and brain abscess caused by Bacillus cereus is reported. Without performing any surgical procedures, the patient was successfully treated with systemic antimicrobial therapy combined with granulocyte colony stimulating factor, which contributed to the increase in the neutrophil count.
Endovascularly treated cerebral aneurysm using Guglielmi detachable coils acting as a nidus for brain abscess formation secondary to Salmonella bacteremia: case report.
OBJECTIVE AND IMPORTANCE: Intracranial infections related to the various foreign materials used to secure intracranial aneurysms are extremely rare. The lack of neoendothelium formation across the necks of aneurysms, which is particularly prone to occur when the sac is incompletely packed by Guglielmi detachable coils (GDC), results in the absence of isolation of the coils from the circulation. Colonization of GDCs, which act as a foreign-body nidus after hematogenous spread from infections with bacteremia, may result in localized intracranial infection. CLINICAL PRESENTATION: A 55-year-old woman developed meningitis and a brain abscess surrounding a giant aneurysm that was treated endovascularly with GDC 3 1/2 years earlier. Four weeks before she sought care, she experienced an infective illness with proven Salmonella bacteremia. Salmonella group D was isolated from cerebrospinal fluid. INTERVENTION: The patient was treated successfully with long-term cephalosporin therapy. Follow-up imaging studies revealed regression of the abscess. CONCLUSION: This case suggests that the GDC acted as a colonized foreign body, resulting in the surrounding abscess formation after infection with Salmonella bacteremia. Alternatively, the reaction of the surrounding tissue to the GDC was the predisposing factor and acted as the nidus for the abscess formation.
INFECTION WITH HAEMOPHILUS APHROPHILUS: BRAIN ABSCESS.
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Brain abscess associated with isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect.
A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.
Sepsis and multiple brain abscesses caused by Salmonella paratyphi B in an infant: successful treatment with sulbactam-ampicillin and surgical drainage.
Abscess formation by Salmonella species is an uncommon but significant manifestation of salmonellosis, because this type of infection has high morbidity and mortality rates and is a potential nosocomial hazard. In infants, history of consumption of contaminated water should be especially quired. We report a case who had sepsis and multiple brain abscesses due to Salmonella paratyphi B and who responded to sulbactam-ampicillin (SAM) therapy. Sulbactam-ampicillin combination may be preferable due to its immunomodulator effect.
Brain abscess due to Scedosporium apiospermum in a non immunocompromised child.
Scedosporium apiospermum is a filamentous fungi that commonly causes cutaneous infection. In certain circumstances, S. apiospermum can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited and the prognosis is poor. Early identification and treatment can decrease the mortality rate. Here we present a case of brain abscess with chronic suppurative otitis media, caused by S. apiospermum. This is the first such case report from Nepal. We could identify the organism only post mortem. We could not save the patient, probably due to delay in diagnosis.
Pericarditis, pneumonia and brain abscess due to a combined Actinomyces--Actinobacillus actinomycetemcomitans infection.
A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.
Haemophilus influenzae type b brain abscess complicating meningitis: case report.
A 7-month-old child developed beta-lactamase negative Haemophilus influenzae type b meningitis which was treated with parenteral ampicillin and chloramphenicol for two days and ampicillin for eight additional days. She was readmitted two days after discharge on the 14th day after the initial hospitalization because of a suspected relapse of meningitis. Cultures of CSF and blood yielded no growth, and therapy with ampicillin and chloramphenicol was discontinued after three days. After discharge, her fontanel became full and a large, right, frontoparietal brain abscess was found on her third admission on day 25. Pus from the abscess yielded beta-lactamase negative H influenzae type b but CSF and blood yielded no growth. The abscess resolved after needle aspiration of pus and 4 weeks of therapy with ampicillin and chloramphenicol. It is speculated that this rare complication of H influenzae meningitis arose from a focal infection in an area of brain necrosis that resulted from the initial meningitis.
Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis.
Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with surgical drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.