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Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess

Tuberculous brain abscess.

Brain abscess is probably the least common manifestation of tuberculous infection of the central nervous system. Some authors have made a rigid distinction between tuberculous brain abscess and variants of cerebral tuberculoma. Such a distinction is not supported by our own case of tuberculous brain abscess, or by review of similar, recently reported cases.

Brain Abscess

Pseudallescheria boydii brain abscess: association with near-drowning and efficacy of high-dose, prolonged miconazole therapy in patients with multiple abscesses.

Brain abscess caused by Pseudallescheria boydii is a highly lethal infection, usually seen in immunosuppressed patients. Five patients with P. boydii brain abscesses are described. Four of these patients acquired their infection after near-drowning; 1 patient developed an abscess after penetrating head trauma. Two patients survived their infections, which included involvement of other body sites (lung, eye, bone) as well as multiple undrained brain abscesses, after prolonged courses of high-dose parenteral miconazole (80-90 mg/kg/d). Progressive increases in miconazole dosage during the treatment periods were required to produce serum levels above the minimum inhibitory concentrations of the fungal isolates.

Adult

Brain abscess mimicking brain tumor.

We review our experience with brain abscesses presenting as primary brain tumor over a 5-year period (1983 to 1988). Four of 66 (6%) patients admitted with the diagnosis of primary brain tumor by computed tomographic scans were found at craniotomy to have brain abscesses. Periapical abscesses found after surgery were determined to be the cause of brain abscess in two of four patients. Our experience suggests that periapical abscess may be a more frequent cause of brain abscess than previously thought, and should be considered before surgery in patients with a suspected brain tumor.

Adolescent

[Brain abscess (Part 5)--Brain abscess following internal carotid occlusion (author's transl)].

Three cases of brain abscess following an occlusion of the internal carotid artery were reported. Case 1: A 6-year-old girl with congenital heart disease was admitted with headache, disturbance of consciousness and left hemiparesis. Right carotid angiography revealed an occlusion of the right internal carotid artery. After 6 months, she was readmitted with high fever. CT scan revealed a low density area and a ring-like shadow at the same site of cerebral infarction. Case 2: A 69-year-old man was admitted in semicoma and with right hemiplegia. Left angiography revealed an occlusion of the left internal carotid artery. After 2 months, a brain abscess was noted in the infarcted area. Case 3: A 20-year-old man with congenital heart disease, was admitted due to headache, vomiting and high fever. CT scan revealed a brain abscess in the right frontal lobe. Carotid angiography showed bilateral internal carotid artery occlusion. We concluded that diminution of cerebral oxygen and encephalomalacia are predisposing factors to the evolution of brain abscess.

Adult

[Fatal course of basalioma terebrans caused by brain abscess with brain compression and hemorrhagic anemia].

Report on a 79 years old female patient with a giant basalioma terebrans which has been growing for 15 years at the forehead. Its rapid exophytic and invasive growth at the final stage resulted in an extend destruction of the squamofrontal bone with infiltration into the dura mater. In consequence of this brain abscess with brain compression and a high grade hemorrhagic anemia inducing at last the fatal outcome were developed.

Aged

[Abscess of the brain (2nd report)--special reference to surgical indication of extracapsular excision of brain abscess (author's transl)].

Brain abscess persists as a serious diagnostic problem and critical therapeutic challenge since pre-antibiotic era. After antibiotic agents has been introduced, abscess of the brain seems to be a surgical curable intracranial suppurative disease, although surgical mortality and morbidity due to brain abscess are still distressingly high. Recently, the incidence of brain abscess are gradually increasing. In this present situation, it is necessary to reevaluate the previous method and surgical results of brain abscess. Even with new surgical techniques and antibiotics, the mortality rate and number of neurological deficits remain high, as previously methods, it is most important how to eliminate these problems. It was undertaken to determine the significant factors affecting the clinical management of patients with this serious problem. The general outlines of our neurosurgical treatment are given, with emphasis on our surgical schedule of brain abscess, especially brain abscess in congenital heart disease. In this paper, a review of the current status of the surgical methods, operative mortality and morbidity, diagnostic methods and the therapy of brain abscess has been discussed.

Adolescent

Multiple brain abscesses secondary to bronchiectasis. A case of 34 discrete abscesses in one brain.

Multiple brain abscesses are a rare complication which may occur in a number of conditions including intra-thoracic sepsis. Computerized tomography has had an advantageous impact on the management of this condition by facilitating earlier diagnosis. However, the treatment modalities are inadequate and mortality remains high. A case of multiple brain abscesses in a patient with bronchiectasis is reported which exemplifies this often fatal condition. The management of multiple brain abscesses is discussed.

Adult

[Non-clostridial gas-producing brain abscess in a brain death patient--report of a case].

A 46 year old female was admitted to our emergency room because of cardiopulmonary arrest by hanging. After ten minutes cardiopulmonary resuscitation, she was resuscitated but her consciousness did'nt recover. CT-scans on the day of admission showed no abnormalities but on the second hospital day it showed symmetrical low density areas within the basal ganglia, the thalamus, the hippocampus, and the occipital lobe. There were marked enhanced effect in cerebral sulci due to cytotoxic edema of hypoxic encephalopathy. She was comatose for a week, her pupils were dilated, light reflex and other brain stem reflex were absent. CT-scans on the sixth hospital day showed marked brain swelling with disappearance of the ventricular systems (so called brain tamponade). Brain death was confirmed on the basis of Japanese Criteria on the seventh and tenth day of admission. She had been suffering from pneumonia and urinary tract infection with an elevation of temperature since the fourth hospital day. We detected Enterobacter Cloacae (E. Cloacae), Klebsiella Oxytoca from the cultures of sputum and urine. On the tenth hospital day her temperature was running up to 39.4 degrees C and blood count revealed a peripheral blood leucocytosis of 40,300/mm3 with a shift to the left. E. Cloacae was also detected from the cultures of blood. Skull roentgenogram showed multiple gas collections in the ventricular systems. CT-scans on the fourteenth hospital day showed multiple gas-containing brain abscess. The etiology of this infection was considered due to septicemia of E. Cloacae. She died from acute renal failure on the fifteenth hospital day. Consent for autopsy was not accepted.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Abscess

[A case of Osler-Weber-Rendu disease with brain abscess; the mechanism of the formation of brain abscess and its treatment in Osler-Weber-Rendu disease].

A 54 year-old man, who had a hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease; O-W-R) accompanied by pulmonary arteriovenous fistulas (PAVFs) and congestive heart failure, developed seizure, right hemiparesis and dysphasia. A brain CT scan revealed a cystic lesion with perifocal edema in left frontoparietal lobe. A contrast enhanced CT scan showed a ring-like enhancement. Dynamic CT scans disclosed that the ring in the cortical side was enhanced more thickly than that in the ventricular side. Considering the severity of the cardio-pulmonary condition, and the deep location of the abscess, we performed an echo-guided aspiration and drainage of the abscess under local anesthesia. No bacteria were demonstrated in the culture of the contents of the abscess. After the surgery, the right hemiparesis and dysphasia were much improved and a CT scan showed the marked reduction of the abscess. However, around eight days after the surgery, the patient showed severe pleural effusion due to progressive heart failure and died on the 11th postoperative day. Autopsy disclosed a shrunken brain abscess, multiple cerebral infarction, multiple PAVFs and severe constrictive pericarditis which was regarded as the cause of death in the patient. In this report, we presented the therapeutic advantage of echo-guided surgery for the treatment of brain abscess in a high-risk patient. We also discussed the mechanism of the formation of brain abscess in patients of O-W-R disease by reviewing published cases.

Arteriovenous Fistula

Relevance of antibiotics in the treatment of brain abscesses. Report of a case with eight simultaneous brain abscesses treated and cured medically.

A case of eight simultaneous brain abscesses in the right cerebral hemisphere, treated medically after puncture of two of them, is reported. Antibiotics and hypertonic mannitol and, after seven days, dexamethasone were sufficient to cure these lesions. CT scan was of primary importance to follow the evolution under treatment. To get the best efficiency from antibiotics, identification of the microorganism and assessment of its resistance to antibiotics are necessary. It is suggested that in certain conditions medical therapy might be sufficient to treat cerebral abscess, after simple puncture to isolate the infecting agent. Corticosteroids should be avoided in the acute phase because they prevent antibiotics from penetrating the abscesses.

Adult

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

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

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