PubMed · 12954754
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Munib Mundia. 2003-09-04. Case 16-2003 - brain abscess.. https://doi.org/10.1056/nejm200309043491019
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BACKGROUND: Intracranial tuberculous (TB) abscesses still cause a diagnostic dilemma on both CT and MRI as they may mimic neoplasms. Recognition of TB abscesses may prompt further imaging and appropriate trial of therapy, and may reduce the need for biopsy. OBJECTIVE: To report the CT features of eight intracranial TB lesions in children initially diagnosed as neoplasms and eventually treated as TB abscesses. MATERIALS AND METHODS: We undertook a 3-year retrospective review of children with an initial CT diagnosis of intracranial neoplasm who were subsequently diagnosed as having TB abscesses. RESULTS: Eight patients out of 60 with an initial diagnosis of a neoplasm on CT were misdiagnosed and were ultimately determined to have TB abscesses after biopsy or a trial of anti-TB therapy. The most consistent constellation of findings for the lesions were low density (n = 5), ring enhancement (n = 8), cerebral hemisphere location (n = 7), mass effect (n = 6), surrounding oedema (n = 5) and absence of a soft-tissue-density mass (n = 8). CONCLUSION: In endemic regions, intracranial lesions with these appearances on CT should undergo further imaging and possibly a trial of anti-TB therapy before considering biopsy.
BACKGROUND: This report presents a child with spinal cord lesion with concomitant multiple brain abscesses caused by brucellosis. CASE REPORT: A 12-year-old boy was admitted with quadriplegia accompanied by back pain, headache, nausea, and incontinence which appeared six months before. MRI revealed multiple brain abscesses as well as spinal intramedullary lesions. The diagnosis of brucellosis was established by positive serum Wright test (1:2560) and 2-mercaptoethanol agglutination titer (1:2560), history of exposure, and gradual improvement in response to treatment (rifampin, trimethoprim/sulfamethoxazole, gentamicin, and prednisolone). CONCLUSIONS: Neurobrucellosis may present with uncommon manifestations in children. Physicians should consider this in the differential diagnosis of a child with quadriplegia.
BACKGROUND: Neonatal brain abscesses are very rare and their clinical presentation is specific for this age group. They usually occur as a complication of bacterial meningitis or septicemia. They are most often caused by gram-negative organisms, and mortality and morbidity are still significant in this particular group of patients in spite of antibiotics and modern radiological tools. METHODS: We report an unusual case of a multiloculated brain abscess in a term neonate caused by Staphylococcus aureus. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, mother's disease, or immune defect. The onset of infection in this case was not clear and image features mimicked a brain tumor in the initial evaluation. The infant was successfully treated by primary surgical excision of the lesion and a 6-week total course of intravenous antibiotics. CONCLUSION: The interest of this case lies in the rarity of the causative organism and the atypical features of clinical and neurological images in a term neonate.