[Case of multiple cerebellar abscesses associated with brain abscess].
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Abscess↗
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Brain abscess: an update.
Brain abscess has been a known complication of head trauma, dental and rhinogenic infections and congenital heart defects, but is rapidly becoming a new diagnosis in the ever-growing population of the immunocompromised patient. Organ transplantation has become commonplace. But, with the advent of more sophisticated agents to prevent organ rejection, comes the threat of brain abscess. In addition to the transplanted patient, the acquired immunodeficiency syndrome patient population is also at risk for development of brain abscess, making brain abscess an important diagnosis. A combination of surgical excision and antimicrobial therapy is usually indicated. Nursing care of these patients involves current knowledge of the antimicrobial agents used and their adverse effects, as well as availability of home health services and need for follow-up care.
Brain Abscess↗
Endoscopic stereotactic treatment of brain abscesses.
Treatment of brain abscess is still a subject of controversy. Craniotomy with primary extirpation and resection of the abscess membrane, burrhole craniotomy with puncture or insertion of a drain, marsupialization, or stereotactic aspiration are different therapeutic approaches. As a consequence of our experiences and results with neuro-endoscopic interventions we have introduced endoscopic stereotactic techniques in brain abscess treatment. Seven patients with brain abscesses were operated on stereotactically using an endoscope. In all cases the abscess contents were aspirated, while the abscess membrane was left in situ. The patients received postoperative antibiotic therapy according to microbial diagnosis. The longest follow-up period was 48 months. Six patients showed a marked improvement of neurological deficit after treatment. One patient died from sepsis caused by a bacterial endocarditis. The results emphasize that endoscopic stereotactic technique as a minimally invasive neurosurgical method can also be used for treatment of brain abscess.
Adult↗
Current concepts in the pathogenesis and management of brain abscesses in children.
Brain abscesses represent the most frequent intracranial suppurative process occurring in children. Improved bacteriologic techniques for isolating anaerobic microorganisms have shown that anaerobes play a major role in brain abscesses in conjunction with aerobic organisms such as alpha-streptococci. Computerized tomography has improved the diagnosis of brain abscesses and has changed the management in certain circumstances. Although surgical drainage still remains the definitive treatment modality, conservative medical management with serial CT scans has been successful. Still, the mortality and morbidity of brain abscesses remain substantial.
Brain Abscess↗
Editorial: Brain abscess.
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Brain Abscess↗
Vancomycin and brain abscess.
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Brain Abscess↗
Clinical path conference. Pneumococcal meningitis and brain abscess.
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Otogenic brain abscess in childhood.
Brain abscesses are quite rare complications of middle ear infections. Although temporal lobe abscesses are more common than cerebellar abscesses, the converse was found to be true in our series of 10 cases. Eight cases of cerebellar abscess and 2 cases of temporal lobe abscess in the paediatric age group were reported including 4 cases of latent brain abscesses which manifested themselves after mastoidectomy for middle ear infection. Brain abscess is by far the most serious of otogenic complications.
Adolescent↗
[A clinical survey of brain abscess (3rd report): special reference to chronological analysis of EEG on brain abscess (author's transl)].
The attention of those concerned with the management of intracranial abscess has been largely directed to a study of the findings in clinicopathological and neuroradiological investigations. Our object, in this communication is to arouse interest in the electroencephalographic survey, especially chronological electroencephalographic study of absecess patients. The clinical material forming the basis of this study is drawn from a series of 46 consecutive cases of intracranial abscess treated, during 3 years, in the neurosurgical department of Tokyo Women's Medical College.
Adolescent↗
Brain abscess in infants.
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.
Brain Abscess↗
Home antibiotic therapy for brain abscesses.
Patients with brain abscesses now have the option of receiving intravenous antibiotic therapy at home. However, before discharge from the hospital, these patients require significant education in aseptic technique, general catheter care, medication administration, and troubleshooting. Also provided is a review of the pathology, signs, symptoms, diagnosis, and treatment of adult brain abscesses.
Anti-Bacterial Agents↗
Difficulties in the diagnosis of brain abscesses.
The diagnosis of brain abscesses has been improved during the last 10 years because to introduction of computerized tomography (CCT) and improved methods for the analysis of cerebrospinal fluid (CSF). Typical ring-like enhancement in the CT and an elevated CSF cell count combined with disturbances of the blood-brain barrier and elevated CSF lactate are common and confirm preliminary diagnoses. However, in spite of these procedures, brain abscess is still sometimes misdiagnosed because of the lack of pathological CT findings or a misleading case history sometimes causing cerebral affections. We present the case histories of two young patients in whom diagnosis of brain abscess was delayed. We recommend the immediate performance of contrast-enhanced CT and CSF analysis. If these procedures do not exclude a brain abscess, antibiotic treatment should be begun immediately.
Adult↗
[CT-guided stereotactic surgery of brain abscess].
Seven patients with brain abscess underwent CT-guided stereotactic aspiration using Iseki's stereotactic apparatus. Three of them were under the age of fifteen and four were older than thirty. The lesions were single and round in four cases, multilobular in two and multiple in one patient. Operations were performed after systemic administration of antibiotics for more than two weeks and after capsule formation was confirmed on CTs. Preoperative volume of the abscesses was estimated from CTs. The target point chosen was the center of the ring of the largest diameter in the enhanced lesion. Abscess was aspirated under monitoring with intraoperative CT scan. No continuous drainage was performed and no antibiotics were given directly into the abscess cavity. In all cases the center of the abscess was punctured with a single trial. Average volume of the preoperative brain abscesses was 18.8ml. Aspirated volume at the time of the operation averaged 16.9ml and all the abscesses decreased to unmeasurable size on CTs. In five of seven patients abscesses were cured after a single aspiration, and in one case after the second operation. One case required extirpation of the lesion. During the follow-up period of four months to five and a half years six patients showed no recurrence. One patient died of unrelated cause four and a half years after the operation. No operative complication was noted. There was no operative morbidity or mortality. Using a CT guided stereotactic method, brain abscess is punctured so accurately, regardless of its location and size, that damage to the surrounding brain during operation can be minimized. Therefore it is highly possible to aspirate abscesses completely.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Eikenella corrodens as a cause of brain abscess.
A case of brain abscess due to Eikenella corrodens in a 67-year-old woman is reported. To our knowledge, this is the first case in which the causative organism has been isolated from the occipital lobe. E. corrodens may be the cause of apparently sterile brain abscesses encountered in neurosurgery and should be considered in the differential etiology of brain abscess.
Aged↗
[Etiology of brain abscesses in children].
Data on 67 children treated for abscess of the brain in 1966-1984 years are analysed. The work deals with study of the etiology of brain abscesses in children and the possibility of their prevention. Comparative analysis of the causes of brain abscesses in different age groups (from 10 weeks to 15 years) shows pyoinflammatory skin diseases to be the most common cause of brain abscesses in young children, in those under the age of 12 months in particular. In the next age groups the incidence of cerebral abscesses caused by pyogenic diseases of the skin reduces whereas that of abscesses of otorhinosinusogenic origin increases.
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Development and characterization of an experimental model of brain abscess in the rat.
Brain abscesses were produced in the rat by direct intracerebral injection of agarose beads laden with Staphylococcus aureus. The method proved to be easy, reproducible, effective and was associated with a low mortality rate. The histopathologic features of the experimental abscess are similar to other animal models and to human abscesses. The encapsulation of the lesion, macrophage/microglial response, astrocytic activation, and changes in the surrounding brain parenchyma were studied by immunohistochemistry. Edema, diffuse microglial activation and diffuse astrocytosis characterized the early reaction of the injected cerebral hemisphere. After day 10, edema subsided, and the microglial and astrocytic responses became restricted to the area around the lesion. Fibronectin deposition in the capsule preceded the appearance of myofibroblasts, which was concurrent with the beginning of collagen deposition on day 9. Hypervascularity of the capsule appeared as early as day 6 and persisted through day 28. This study suggests that brain abscess formation can be separated into three components: an initial period of edema and glial activation; an intermediate phase of neovascularization and fibronectin deposition; and a final phase of collagen deposition and progressive fibrosis. This new model offers an excellent paradigm for the analysis of neural tissue reaction and de novo fibrous tissue deposition.
Animals↗
[Conservative treatment of brain abscesses].
The authors present 6 patients with brain abscesses treated conservatively. There were multiple brain abscesses in 4 patients. The patients were in good general condition without marked symptoms of high intracranial pressure. The conservative treatment lasted 4 to 11 weeks under CT control and careful observation of clinical status. 5 patients were cured, 4 of them without any neurological deficit and 1--with visual field defect after bilateral brain abscesses in occipital lobes. 1 patient died in spite of drainage of the biggest of multiple abscesses. The authors confirmed the value of conservative treatment in selected cases of brain abscess, specially in multiple brain abscesses. The early beginning of such treatment seems to be specially important.
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[Neuroradiological follow-up studies of conservatively treated brain abscesses].
Five cases of brain abscess were treated conservatively with antibiotics only. Possibilities and limitations of nonsurgical cure of focal intracranial infections are discussed. Different formation of brain abscess during conservative management are shown with the aid of serial computer tomography. The value of non-invasive CT follow-up studies is compared with other conventional neuroradiological investigations.
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