Biomedical subjects

Hung-Chen Wang

Publications and source records attributed to Hung-Chen Wang.

7 recordsLinked to original sources

PubMed2006

Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses.

BACKGROUND: Intraventricular rupture of brain abscesses (IVRBA) remains a catastrophic and fatal complication of bacterial brain abscess (BBA). However, no information has been reported about the risk factors that are predictive of intraventricular rupture. METHODS: This study was undertaken to determine the potential risk factors that are predictive of intraventricular ruptures in patients with BBA but without intraventricular rupture when arriving at the hospital. A comparison is also made between patients who already have IVRBA at the time of admission (initial IVRBA) and those who have the episode during hospitalisation (subsequent IVRBA). RESULTS: 62 patients, including 45 who had initial IVRBA and 17 who had subsequent IVRBA, were examined. Stepwise logistic regression analysis showed that the adjusted risk of intraventricular rupture during hospitalisation for patients with multiloculated brain abscesses had an odds ratio (OR) of 4.2 (95% confidence interval (CI) 1.24 to 14.3; p = 0.02) compared with those without multiloculated brain abscesses (referent); a reduction of 1 mm in the distance between the ventricle and brain abscesses would increase the rupture rate by 10% (p = 0.006, OR 0.9, 95% CI 0.83 to 0.97). CONCLUSION: This study shows that if the abscess is deep seated, multiloculated and close to the ventricle wall, a reduction of 1 mm in the distance between the ventricle and brain abscesses will increase the rupture rate by 10%. Despite aggressive medical and surgical management shown in this series, many patients continue to progress poorly.

Adolescent↗

PubMed2006

Tension pneumocephalus--a rare complication of radiotherapy: a case report.

We present a rare case of tension pneumocephalus due to high-dose radiotherapy used to treat nasopharyngeal carcinoma. A skull base defect causing tension pneumocephalus was identified and was repaired successfully. The case emphasizes the importance of careful consideration before applying irradiation treatment to patients with head and neck malignancy and urges early detection of potentially life-threatening complications.

Drainage↗

PubMed2006

Post-traumatic hemifacial spasm.

We report an early-onset post-traumatic hemifacial spasm and discuss possible aetiology. A 20-year-old man was admitted to our hospital for observation because of an injury to the right frontotemporal region, resulting in drowsiness. On the second day in hospital, he developed peripheral paresis of the facial nerve on the right, followed by hemifacial spasm on the same side. He improved after corticosteroid treatment, and was discharged one week later almost completely recovered. The neuroradiology and clinical response suggest that the patient's hemifacial spasm was due to hyperexcitability of the facial nerve nucleus induced by a haematoma in the lower central pons.

Adult↗

PubMed2005

The significance of seizures and other predictive factors during the acute illness for the long-term outcome after bacterial meningitis.

BACKGROUND: Seizures are important neurological complications of bacterial meningitis, but no information about its epidemiology and the outcomes of seizures after community-acquired bacterial meningitis (CABM) in an adult population have been reported. AIMS: To determine the frequency, clinical relevance, subtypes of seizures during the acute phase of bacterial meningitis, and the long-term outcomes of seizure complicating adult CABM. METHODS: In this 12-year retrospective study, 117 adult patients were identified with culture-proven CABM. A comparison was made between the clinical data of the patients with and without seizures during hospitalization. RESULTS: Thirty-one patients had seizures during CABM, accounting for 27% (31/117) of the episodes. The time interval between the onset of bacterial meningitis and the seizures was 1-21 days (mean, 4 days). Furthermore, 80% (25/31) of the episodes occurred within 24 h of presentation. Ten patients who had seizures progressed to status epilepticus. At follow-up after completing treatment, 10 patients completely recovered and were seizure-free, 19 died of meningitis during the acute stage and the other two progressed to chronic epilepsy. CONCLUSION: A log-rank test demonstrated that the long-term outcome of adult CABM with acute seizures produced worse outcomes than for those who had no seizures, though no difference was noted between focal and generalized seizures. None of our patients without seizures in the acute phase of bacterial meningitis developed late seizures during the follow-up periods. Poor outcome in this study may attribute to neurological complications such as seizure, hydrocephalus, infection itself, or a combination of complications.

Aged↗

PubMed2005

Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes.

The clinical data of 62 adult patients who suffered post-neurosurgical nosocomial bacterial meningitis, retrospectively collected over a 16-year period, were studied. Cases were divided into two groups based on the date of presentation, the first period being 1986-1993 and the second 1994-2001. Fever and progressive consciousness disturbance were the most consistent clinical features - signs that may also be attributed to other postoperative neurosurgical problems. The common pathogens included Staphylococcus aureus, coagulase negative Staphylococcus, Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. An increase in polymicrobial infections and multi-antibiotic resistance during the second period was identified. In the first half of the study, mortality was 22%, and in the second half 36%. Adult post-neurosurgical nosocomial bacterial meningitis has become an important clinical problem. The choice of appropriate empirical antibiotics is challenging and must be guided by an awareness of the relative frequency of various pathogens and the increasing incidence of resistant strains. Although high mortality rates may, in part, be related to the primary brain pathology, early diagnosis and the timely use of antibiotics based on antimicrobial susceptibility testing are essential for survival.

Adolescent↗

PubMed2005

Clinical relevance of hydrocephalus in bacterial meningitis in adults.

BACKGROUND: The predictive factors, clinical relevance, and outcomes of hydrocephalus complicating adult bacterial meningitis were studied. METHODS: In this 16-year retrospective study, 136 adult patients were identified with culture-proven bacterial meningitis. A comparison was made between the clinical and cerebrospinal fluid data of patients with and without hydrocephalus on admission. RESULTS: Twenty-eight patients had hydrocephalus secondary to bacterial meningitis, accounting for 21% (28/136) of the episodes. Of the 28 patients, the initial computed tomographic scans and/or magnetic resonance imaging studies revealed hydrocephalus in 27 patients, and delayed hydrocephalus developed despite commencement of antimicrobial therapy in the remaining patient. The interval from initial symptoms to external ventricular drainage was 3.9 +/- 4.6 days (range, 1-14 days). Among them, 7 patients underwent external ventricular drainage for hydrocephalus during the acute phase of bacterial meningitis. At follow-up of at least 6 months or more, 14 patients survived and 14 died, with an overall mortality rate of 50%. CONCLUSION: In this study, disturbed consciousness and a higher mean age at the time of admission are risk factors for developing hydrocephalus during the acute phase of bacterial meningitis. Poor outcomes are also found in this specific group of patients, and these may be attributed to the infection itself, hydrocephalus, or both. Because of fulminated clinical courses and high fatality rates, surgical intervention may be suitable only for those who have progressive hydrocephalus and are neurologically stable. In spite the high fatality rate, adequate treatment of neurologic complications and aggressive antimicrobial therapy are essential in improving therapeutic outcomes.

Adult↗

PubMed2004

An adult case of Chryseobacterium meningosepticum meningitis.

Chryseobacterium meningosepticum is an uncommon pathogen causing adult bacterial meningitis. Herein, we report the case history of one 21-year-old woman with this uncommon central nervous system infection. A diagnosis of adult C. meningosepticum meningitis can only be confirmed by a positive cerebrospinal fluid (CSF) culture. The patient had insulin-dependent diabetes mellitus as the underlying condition associated with this infection. The clinical presentations were fever, headache, consciousness disturbance, and seizure. CSF analysis revealed a purulent inflammatory reaction. After a 21-day course of intravenous cefepime (6 g/day) treatment, this patient was discharged in a state of complete recovery.

Adult↗