Clinico-radiological presentation and outcome of brain abscess in congenital cyanotic heart disease

Abstract

Introduction Patients with congenital cyanotic heart disease (CCHD) are at increased risk of developing brain abscesses. Having a brain abscess is itself a risk for the patient and concomitant cyanotic heart disease makes it a double jeopardy. The management of brain abscesses depends on the size, number, stage, and location of the abscess and can be medical and surgical. Methods This retrospective chart review was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal between January 2019 and December 2023. Demographic and clinical profiles, imaging studies, treatment modalities, and outcomes were analyzed. Results Out of 17 patients, 11 were males and six were females. The mean age of the study population was 13.41 +/- 11.08 years. The most common associated cardiac problem was Tetralogy of Fallot seen in six (35.3%) patients and the most common abscess site was the parietal lobe (38%). The most common presenting symptom was vomiting, seen in 76%. Twelve patients underwent burrhole and aspiration and 17.6% of patients underwent surgical excision of the abscess wall whereas 11.7% of the patients were managed conservatively. Positive culture was seen in 33.3%. S. aureus was the most common organism grown. There was no mortality. Conclusion High index of suspicion for brain abscess is necessary in patients with congenital cyanotic heart disease. Early diagnosis and treatment lead to a favorable outcome.