Abstract
PurposeBrainstem abscess is a rare condition accounting for merely 1% of brain abscesses incidence in the pediatric population. This study aimed to present a single patient with a pontine abscess and review the literature to highlight clinical features, diagnosis, and management of brainstem abscess.MethodsThe PubMed database was screened for English-language articles concerning pediatric brainstem abscess. We, therefore, identified 22 publications, which concisely depict 23 cases. Our study reports on the 24th pediatric patient diagnosed with that entity. All included reports were analyzed in terms of clinical presentation, diagnosis, management, and outcomes of described patients.ResultsThere was slight women predominance (15:9), with a mean age of occurrence 6.4 years, ranging from 7 months to 16 years. Pons was the most common location of brainstem abscess, occurring in 75% of patients. Clinically, they mostly presented with cranial nerves palsy (79.2%), hemiparesis (66.7%), and pyramidal signs (45.8%). The classic triad of symptoms, including fever, headache, and the focal neurologic deficit was present in 20.8% of patients. Positive pus cultures were obtained in 61.1%. Streptococci and Staphylococci were the most frequently identified pus microorganisms. Outcomes were satisfactory, with a 79.2% rate of general improvement.ConclusionsNeurosurgical aspiration is a safe and beneficial therapeutic method. It should always be considered and should promptly be performed when the conservative treatment is not successful and clinical deterioration occurs. Prognosis in pediatric brainstem abscess is generally favorable. Most patients recover with minor neurologic deficits or improve completely.
Highlights
Brain abscess is defined as a collection of pus in the brain parenchyma
There is no evidence supporting the dominance of one surgical technique in the treatment of brainstem abscess in children
Brainstem abscesses are rare findings, with merely 24 pediatric patients being described in the literature so far
Summary
Brain abscess is defined as a collection of pus in the brain parenchyma. It appears typically in a devitalized area or affected by poor microcirculation [1]. Nathoo et al report that 42% of brain abscesses appear in the pediatric population [3]. Their typical location includes frontal, Childs Nerv Syst. The first pediatric patient diagnosed with brainstem abscess was presented in 1974 by Danziger et al [8]. The mean age of occurrence in cerebral abscesses ranges between 4 and 7 years [28]. Considering brainstem abscesses, the mean age of occurrence during childhood was 6.4 years, ranging from 7 months to 16 years. Abscess involving more than one part of the brainstem was seen in 7 patients (29.2%); thereof, only one patient presented with entire brainstem neuroaxis affected (midbrain, pons, and medulla)
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