PubMed · 492016
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D A Simpson, P L Reilly. 1979-06-30. Intracranial abscess.. https://pubmed.ncbi.nlm.nih.gov/492016/
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The case of a newborn infant who developed meningitis caused by E. coli is presented. During i.v. treatment with ampicillin and gentamycin in recommended doses and according to susceptibility patterns, the patient developed cerebral abscesses detected on CT. After changing to third generation cephalosporin, the patient improved clinically and the CT-changes regressed and disappeared. Because of their superior bactericidal effect, we recommend a third generation cephalosporin as a first choice in the treatment of neonatal E. coli meningitis.
Brain abscesses are rare in infants and their clinical presentation is specific for this age group. Seven cases of brain abscess in infants aged 2-11 months are reported. The underlying cause was meningitis in four, sepsis in two, and unknown in one. Gram-negative organisms were cultured in 6 patients. The abscess size was 5 cm or more in five cases; in four there were multiple lesions. Two abscesses were aspirated and irrigated; four particularly large lesions were drained and repeatedly aspirated and irrigated. One craniotomy was done. There were two deaths, one in the postoperative period and the other 6 months after discharge. Follow-up information is available for four children, showing a good result in only one of them. Formation of an abscess should be diagnosed early, and close ultrasound monitoring or CT scanning in infants with bacterial meningitis and sepsis is essential. The prognosis in cases in which large/multiple abscesses develop is poor.
The brainstem abscess of a nine-year-old girl with tetralogy of Fallot was cured after six weeks of parenteral antibiotic therapy, without surgical intervention. Serial studies of brainstem auditory evoked potentials were undertaken until the patient was clinically normal. To the authors' knowledge, this is only the second medically cured case reported in the literature, and it is the first case studied with serial brainstem auditory evoked potentials. If the clinical status allows, medical treatment of a brainstem abscess with appropriate antibiotics could be tried before surgical intervention such as stereotactic aspiration for reducing the mass.