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Two Cases of Brain Abscess Relapsing after Suboptimal Surgery  [cached]
Elif Tükenmez-Tigen,Fatma Sarg?n,Arzu Do?ru
Klimik Journal , 2012,
Abstract: Although brain abscess may occur without evident risk factors, well-known risk factors are diabetes mellitus, head trauma, neurosurgical operations and immunosuppression. We present two cases of brain abscess, the first due to Klebsiella pneumoniae in a patient with diabetes mellitus as a risk factor, and the second due to Pseudomonas sp. in a patient without any known risk factor. Both patients required reoperation for relapses after initial operations performed partially because of the locations of the abscesses.
Clinical and Radiological Features in the Cases with Cryptogenic Brain Abscess in Association with Patent Foramen Ovale: A Case Report and Review of the Literature  [PDF]
Masayuki Sugie, Takahiro Jimi, Yojiro Kashimura, Hiroo Ichikawa
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.521178
Brain abscesses are commonly associated with cranial trauma, a contiguous focus of infection, or hematogenous spread from a distant focus. However, no predisposing factors are identified in approximately 4% of the cases, being recognized as a cryptogenic brain abscess (CBA). Here we report a patient with a CBA in the left occipital lobe presumably caused by a periodontal disease. The patient displayed a patent foramen ovale (PFO), through which a spontaneous right-to-left shunt was revealed with transesophageal echocardiography. A literature review indicated that in contrast to cases of general brain abscesses, patients with CBA were older and mostly had dental disorders represented by periodontal diseases and a large PFO. In these patients, the abscess was located predominantly in the posterior circulation area, and their prognosis was worse than that of general cases. Consequently, we emphasize the significance of screening for PFO in cases of advanced age with CBA in the posterior circulation region. Furthermore, to avoid neurological sequelae, we suggest immediate surgical drainage with antibiotic administration and maintenance of oral hygiene.
Giant hemispheric multiloculated brain abscess  [cached]
Liu Wen-ke,Ma Lu,Mao Bo-yong
Neurology India , 2009,
Brain Abscess in Children
M Faraji,F Samini
Iranian Journal of Pediatrics , 2005,
Abstract: Background: Brain abscess is one of the most important diseases among the neurosurgical infectious diseases which is accompanied by considerable mortality and morbidity. The aim of this research is contemplation of brain abscess in children (5-12 years) to ascertain the incidence, effectual underlying factors, clinical and laboratory findings and mortality and morbidity rates in Ghaem hospital in Mashad since 10 years ago. Methods: This is a descriptive and analytic study in children with brain abscess in Ghaem hospital achieved retrospectively. We considered age, sex, underlying factors, clinical and laboratory findings, location of abscess, methods of treatment (medical or surgical), the duration of staying in hospital, and mortality and morbidity of the disease. Statistical analysis was achieved with Odds Ratio and Chi2 test. Findings: The age of children with brain abscess was 5-7 years. Male to female ratio was 1.6 to 1.The most common underlying factors for brain abscesses were acute and chronic diseases of ear, mastoiditis, and chronic cyanotic heart disease (CCHD). The patients had fever (55.5 %), headache (46.6%), focal neurological findings (64.6%) and altered consciousness in 46.7%. The most common sites of involvement were: temporo-parietal (20%) and parietal lobe (18.2%). Pus culturing was positive in 34% of cases. In 73.3% of cases one organism and in 26.6% several organisms were found in the culture. We achieved aspirated type operation in 93.3 % of cases. The incidence of mortality and morbidity was 17.7% totally. The mortality and morbidity rates in patients with CCHD and otogenic brain abscess were 11.1% and 22.2% respectively. There was no meaningful correlation between mortality and morbidity with the number of abscesses or patient’s age. Conclusion: Attention to hygiene of mouth and teeth in pediatric patients with cyanotic heart disease is very important in prevention of infectious brain diseases. We must also consider attention to ear–nose–throat diseases of children. It is very important that the patients are examined again after treatment because of finding and treatment of unknown otitis and chronic sinusitis.
Zafar Iqbal
The Professional Medical Journal , 1999,
Abstract: A study of 50 cases of brain abscess is presented, emphasis being on clinical presentation and earlydiagnosis. A comparison is made with other studies and recommendations are made for early diagnosis.
Metastatic amoebic abscess of the brain  [cached]
Deodhar S,Trivedi Vatsala,Desai A,Murthy Anuradha
Journal of Postgraduate Medicine , 1979,
Abstract: A case-of Amoebic abscess of brain is presented and relevant Literature reviewed.
Pyogenic brain abscess, a 15 year survey  [cached]
Helweg-Larsen Jannik,Astradsson Arnar,Richhall Humeira,Erdal Jesper
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-332
Abstract: Background Brain abscess is a potentially fatal disease. This study assesses clinical aspects of brain abscess in a large hospital cohort. Methods Retrospective review of adult patients with pyogenic brain abscess at Rigshospitalet University Hospital, Denmark between 1994 and 2009. Prognostic factors associated with Glasgow Outcome Score (GOS) (death, severe disability or vegetative state) were assessed by logistic regression. Results 102 patients were included. On admission, only 20% of patients had a triad of fever, headache and nausea, 39% had no fever, 26% had normal CRP and 49% had no leucocytosis. Median delay from symptom onset to antibiotic treatment was 7 days (range 0–97 days). Source of infection was contiguous in 36%, haematogenous in 28%, surgical or traumatic in 9% and unknown in 27% of cases. Abscess location did not accurately predict the portal of entry. 67% were treated by burr hole aspiration, 20% by craniotomy and 13% by antibiotics alone. Median duration of antibiotic treatment was 62 days. No cases of recurrent abscess were observed. At discharge 23% had GOS ≤3. The 1-, 3- and 12-month mortality was 11%, 17% and 19%. Adverse outcome was associated with a low GCS at admission, presence of comorbidities and intraventricular rupture of abscess. Conclusions The clinical signs of brain abscess are unspecific, many patients presented without clear signs of infection and diagnosis and treatment were often delayed. Decreased GCS, presence of comorbidities and intraventricular rupture of brain abscess were associated with poor outcome. Brain abscess remains associated with considerable morbidity and mortality.
Immunopathogenesis of brain abscess
Tammy Kielian
Journal of Neuroinflammation , 2004, DOI: 10.1186/1742-2094-1-16
Abstract: Brain abscesses develop in response to a parenchymal infection with pyogenic bacteria, beginning as a localized area of cerebritis and evolving into a suppurative lesion surrounded by a well-vascularized fibrotic capsule. The leading etiologic agents of brain abscess are the streptococcal strains and S. aureus, although a myriad of other organisms have also been reported [1,2]. Brain abscess represents a significant medical problem, accounting for one in every 10,000 hospital admissions in the United States, and remains a serious situation despite recent advances made in detection and therapy [2]. In addition, the emergence of multi-drug resistant strains of bacteria has become a confounding factor. Following infection, the potential sequelae of brain abscess include the replacement of the abscessed area with a fibrotic scar, loss of brain tissue by surgical excision, or abscess rupture and death. Indeed, if not detected early, an abscess has the potential to rupture into the ventricular space, a serious complication with an 80% mortality rate [1]. The most common sources of brain abscess are direct or indirect cranial infection arising from the paranasal sinuses, middle ear, and teeth. Other routes include seeding of the brain from distant sites of infection in the body (i.e. endocarditis) or penetrating trauma to the head. Following brain abscess resolution patients may experience long-term complications including seizures, loss of mental acuity, and focal neurological defects that are lesion site-dependent.At the histological level, brain abscess is typified by a sequential series of pathological changes that have been elucidated using the experimental rodent models described in detail below [3-7]. Staging of brain abscess in humans has been based on findings obtained during CT or MRI scans. The early stage or early cerebritis occurs from days 1–3 and is typified by neutrophil accumulation, tissue necrosis, and edema. Microglial and astrocyte activation is also e
Salmonella brain abscess in an infant  [cached]
Samal Badhuli,Oommen Seema,Swami Anjali,Maskey Madhavi
Indian Journal of Pathology and Microbiology , 2009,
Abstract: Brain abscess is an uncommon and serious life-threatening infection in children. Focal intracranial infections caused by Salmonella spp. in this age group are also rare. We report the case of a 4-month-old male infant with a frontoparietal brain abscess caused by Salmonella typhimurium , the presence of which was not suspected clinically.
Otogenic brain abscess  [PDF]
Ne?i? Vladimir 1,Jano?evi? Ljiljana B.,Stoji?i? Gojko,Jano?evi? Slobodanka B.
Srpski Arhiv za Celokupno Lekarstvo , 2002, DOI: 10.2298/sarh0212389n
Abstract: Chronic inflammation of the middle ear is the most frequent cause of otogenic complications. Meningitis is the most frequent otogenic intracranial complication, followed by otogenic brain abscesses, while other complications are significantly less frequent. The study is aimed at presenting clinical casuistry of otogenic brain abscesses consequential to chronic suppurative otitis in order to evaluate modern diagnostic and therapeutic possibilities. The study was retrospective and included the patients treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery of the Clinical Centre of Serbia diagnosed with otogenic brain abscess during a five-year period (1996-2000). A total of 9 patients (male to female ratio 8:1), aged 16-68 years, were assessed. The following parameters were analyzed: sex, age groups, place of living, occupation number of hospitalizations, diagnostic procedures, symptoms and clinical signs of otogenic complications, other otogenic complications associated with brain abscess, endocranial localization of otogenic abscess therapeutic procedures (oto-surgical treatment) and intraoperative otological findings. In our group of patients, otogenic brain abscesses were significantly more frequent in male patients in their forties, with median age of 33.5 years. As for the place of living, the patients from the provinces were more frequent, while with respect to their level of education, those with elementary or high school degrees were predominant. The inflammatory process most frequently spread into the endocranium through direct destruction of the bone walls of the middle ear. Diagnostic procedures included history, clinical otorhinolaryngological examination audiological and vestibulological assessment, neurological ophthalmolog-ic and radiographie examinations (CT, MRI). CT is the most reliable diagnostic tool enabling localization of the change, timing of surgical treatment and monitoring of surgical success. Presence of other otogenic complications associated with brain abscess was evidenced in six of our patients. Cerebral localization of abscess was more frequent (7). Four patients underwent previous oto-surgical treatment. The treatment included primary neurosurgical approach (radical extirpation or abscess drainage), followed by radical oto-surgical treatment after improvement of the patient's general condition.
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