Brain Abcess Research Articles

Multiple Brain Abscesses In A Child With Infective Endocarditis

Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.

Brain abcess with "Nocardia Farcinica"

Introduction: Brain abscesses caused by Nocardia farcinica pathogen are rare and usually present as large abscesses with a thick and irregular wall. We present a case of a patient with signs and symptoms of central nervous system infection and had a fulminant evolution with malign cerebral oedema and death.
 Case report: The 35-year-old patient presented with mild symptoms that appeared 2 weeks prior and became more aggressive in the last 48 hours. After the initial examination and blood tests, the patient was suspected of a systemic infection because of the high white cell count and high level of inflammatory markers. Antibiotic therapy was started with Ciprofloxacin and Amoxicillin/ Clavulanic Acid. The brain MRI showed a multinodular lesion in the right hemisphere, with contrast enhancement and central high diffusion restriction on T1, T2 and FLAIR. During the antibiotic treatment, the patient suddenly became comatose. Urgent brain CT scan showed malign cerebral oedema with brain shift.
 Discussion: There are 58 documented cases of Nocardia farcinica in the literature, as shown in a recent systematic review. Most of the cases are with immunocompromised patients, either through disease or secondary to treatment after organ transplant. In our case, we suspected immunodeficiencies based on the anamnestic data offered by the patient's family. Mortality rates are between 19% and 36,7% in all reported cases, but in our presented case the patient had a rapid aggressive evolution with malign brain oedema that resulted in death.
 Conclusions. The management of these cases requires urgent diagnostics and treatment. For our team, the first reported case of Nocardia farcinica and the fast aggressive evolution resulted in a negative outcome, even with antibiotics treatment and surgical evacuation of the abscess.

Juvenile high-grade astrocytoma mimicking a cerebral abscess: A case report

IntroductionHigh Grade Astrocytoma (HGAs) is a type of Glioma tumor, observed in less than 15% of all primary neoplasms in the central nervous system, and brain abscess is a relatively rare infection of the parenchyma area. This report is based on HGA cases resembling brain abcesses in girls with symptoms of progressive severe headache accompanied with hemiplegia. Case presentationAn 11-year-old girl was admitted with symptoms of headaches experienced over a period of 4 months. The pain was more progressive, and the patient also has left hemiplegia. Furthermore, head CT scan results with contrast and brain MRI showed a brain abscess (space-occupying lesions – SOL), and tumor removal surgery was performed. The HGA results of Anatomy Pathology were obtained, and therapy was continued with the administration of the HIT-GBM-C protocol. Therefore, a follow-up was performed at 3, 6, 12, and 24 months, and no signs of recurrence were observed. Also, on the outcome of physical examination and brain MRI was within the normal limit. ConclusionThis report shows a rare case of HGA evaluated to share similarities with the incidence of cerebral abscess in children. The tumor diagnosis is based on clinical, radiological and histological examination, principally handled through multi-modality therapy.

Brain Abscess

Although the prognosis of brain abscesses has historically improved, the mortality rate still ranges from 5 to 32%, with ventricular perforation reaching 50% and 85-100% in fungal brain abscesses. The characteristic finding of ring-like enhancement by contrast-enhanced imaging is non-specific, and DWI, SWI and MR spectroscopy are very useful in differentiating brain abcesses from necrotizing brain tumors. Brain abscesses show apparent diffusion restriction on the DWI/apparent diffusion coefficient(ADC) map, whereas necrotizing brain tumors often show a weak diffusion restriction. The "dual rim sign" on SWI is also a highly specific finding of brain abscess.

A retrospective clinical analysis of pediatric paragonimiasis in a Chinese children\u2019s hospital from 2011 to 2019

Diagnosis of pediatric paragonimiasis is difficult because of its non-specific clinical manifestations. We retrospectively reviewed the records of pediatric paragonimiasis in Children’s Hospital of Fudan University from January 2011 to May 2019. The confirmed diagnosis of paragonimiasis was based on positive anti-parasite serological tests from the local Center for Disease Control (CDC). A total of 11 patients (mean age: 7.7 ± 3.1, male–female ratio: 7:4) diagnosed as paragonimiasis were included. 81.8% were from endemic areas such as Sichuan and Yunnan, and 36% had a clear history of raw crab or crayfish consumption. The characteristic clinical features of pediatric paragonimiasis were eosinophilia (100%), pleural effusion (81.8%), hepatomegaly (54.5%), ascites (54.5%), and subcutaneous nodules (45.5%). Misdiagnosed with other diseases including tuberculosis (18.2%), pneumonia (9.1%), intracranial space-occupying lesions (9.1%) and brain abcess (9.1%) led to rehospitalization and prolonged hospitalization. For treatment, a 3-day course of 150 mg/kg praziquantel (PZQ) didn’t show ideal treatment effectivity and 63.6% needed more than one course of PZQ, while triclabendazole in a total dose of 10 mg/kg had a better efficacy to stubborn manifestations. This study indicated that pediatric paragonimiasis was often misdiagnosed, and the treatment with a 3-day course of 150 mg/kg PZQ had a high rate of failure.

A Case of Chronic Invasive Actinomycosis in the Nasal Cavity

A 57-year-old male patient with nasal congestion and nasal congestion, which occurred 1 month prior to the hospital visited. PNS CT and MRI was performed and revealed right orbital cellulitis, sinusitis and brain abcess. Surgical drainage was determined by rhinology, ophthalmology and neurosurgery. The right sphenoid sinus was identified as an open mucosal mucosa, and blackish mucosa was found on the right sphenoid sinus. Eucleation was performed. Infected orbital tissue removal and orbital abscess drainage were performed. Neurosurgery performed dura incision, drainage and removal of a large amount of abscess pattern, and duroplasty with artificial dura. Actinomyces odontolyti was identified by pus culture, and postoperative antibiotic treatment and dressing were performed, but infection aggravation persisted, resulting in deterioration of general condition, multiple organ damage, and cerebral infarction.

Disseminated Nocardiosis with subretinal abscess in a patient with nephrotic syndrome-a case report

BackgroundNocardia infection is uncommon in clinical practice, with most cases occuring as the result of opportunistic infection in immunocompromsed patients. Here, we report a case of disseminated nocardiosis with subretinal abscess in a patient with nephrotic syndrome, and whom is receiving immunosuppressive therapy.Case presentationA 58-year-old male presented with decreased vision in his left eye, without redness or floaters, which had persisted for three days. The patient had previously been diagnosed with membranous nephropathy, and as such, had received systemic corticosteroid therapy for four months. Further, the patient had developed pneumonia three weeks prior to this presentation. The ocular lesion appeared as a creamy-white subretinal abscess, with overlying retinal hemorrhages. Subsequent administration of three intravitreal injections of vancomycin and ceftazidime ultimately led to eradication of the intraocular infection, however, two months later, the patient developed a brain abcess. Pathogens isolated from the blood were subsequently identified as Nocardia. The patient was successfully treated via systemic administration of imipenem and trimethoprim-sulfamethoxazole.ConclusionsClinicians should be aware of the possibility of Nocardia infections within all immunocompromised patients, as well as the tendency of this infection to disseminate--particularly in the brain. The early detection of Nocardia infections and prolonged treatment of the proper antibiotics may significantly improve the prognosis of this life-threatening infection.

Case report: A rarely seen cause of brain abscess - neurotoxocariasis

Background: Toxocariasis is associated with three syndromes in human beings which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this abstract we report a case of brain abcess caused by toxocariasis. Methods & Materials: A 56 years-old female patient admitted at our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few nonspesific intensities at supratentorial white matter, and an approximately 13x12mm lesion without contrast enhancement which had a significant edema around the whitematter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration in histological examination. Results: A spesific agent could not be detected in histochemical examination.Western-blot test toxocariasis in serumand CSFwere positive. She was transferred to the infectious diseases and clinical microbiology clinic.Albendazole 400mg q12h was started. A total of onemonthduration for albendazole treatmentwasplanned after regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, we found out that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semi-ovale. There was no relapse after six month follow up. The Conclusion: The presented case suggests that although rarely neurotoxocariasismaybe encountered in the etiology of encephalitis/brain abcess. The patient was successfully treated with albendazole. To our knowledge this is the first reported case of neurotoxocariasis n Turkey.

The influence of winter on the prevalence of urogenital schistosomiasis in rural southern KwaZulu-Natal

Background: Toxocariasis is associated with three syndromes in human beings which are visceral larva migrans, ocular larva migrans and covert toxocariasis. Although neurotoxocariasis is defined as the fourth syndrome of toxocariasis, it is usually considered as a neurological disease which is usually concomitant with visceral larva migrans. In this abstract we report a case of brain abcess caused by toxocariasis. Methods & Materials: A 56 years-old female patient admitted at our hospital with headache, pain referring to right side of her face and teeth, numbness of forth and fifth finger of her right hand. Cranial diffusion weighted, dynamic magnetic resonance imaging (MRI) revealed a few nonspesific intensities at supratentorial white matter, and an approximately 13x12mm lesion without contrast enhancement which had a significant edema around the whitematter in the left frontal cortex. Histologic examination after stereotactic biopsy of the lesion revealed diffuse histiocyte infiltration in histological examination. Results: A spesific agent could not be detected in histochemical examination.Western-blot test toxocariasis in serumand CSFwere positive. She was transferred to the infectious diseases and clinical microbiology clinic.Albendazole 400mg q12h was started. A total of onemonthduration for albendazole treatmentwasplanned after regression of the cranial MRI findings on the 14th day of therapy. The patient is recalled for cranial MRI control three months later. However, we found out that she continued albendazole for three months. Compared to the previous MRI, there were two stabilized T2A hyperintense lesions in left cranial hemisphere and minimally regressed lesions at the level of left frontal centrum semi-ovale. There was no relapse after six month follow up. The Conclusion: The presented case suggests that although rarely neurotoxocariasismaybe encountered in the etiology of encephalitis/brain abcess. The patient was successfully treated with albendazole. To our knowledge this is the first reported case of neurotoxocariasis n Turkey.

English

Reporting 40 day old child referred from a private clinic to our hospital with CT Brain showing intracranial space occupying lesion. Child had fever since day 7 of birth and was evaluated for sepsis in the nearby hospital and CSF study showed features of bacterial Meningitis and was treated for 14 days with inj. cefotaxime and amikacin. After 3 days of IV medication fever subsided. CSF culture outside did not shown any growth. We have not got the detail of blood investigation outside. CT brain was taken in that private clinic to rule out post meningitic complication. Surprisingly they found intracranial space occupying lesion. So the child was referred to our hospital for further management. On examination child was alert, active feeding well, no any neurological deficit anterior fontanelle was level. Blood investigation showed normal total count (13,000 with polymorphs predominance 70%), CRP was 7 and blood culture has not grown any bacteria. Serum calcium 8mg/dl, potassium 4meq, sodium 130 mEq. CT Brain (taken outside) showed well encapsulated calcified mass in right temporal lobe 3x3 cm with no midline shift. So child was operated (open surgery) and biopsy of the lesion showed abscess with calcification. Pus culture revealed pseudomonas aeruginosa. Child was treated with IV ceftazidime for 10 days. Child went home with no neurological deficit. On follow up he is doing well. DISCUSSION: Calcified brain abscess 1 in infancy is rare and only few cases were reported with abscess and calcification. Brain abscesses can occur in children of any age but are most common in children between 4 and 8 yr and neonates. The cause of brain abscess include embolization due to congenital heart disease with right to left shunts, meningitis, chronic otitis media, sinusitis, orbital cellulitis, dental infection, immunodeficiency and infection of ventriculoperitoneal shunts. Our patient had CSF proven meningitis treated with antibiotic for 14 days. He did not have any neurological symptoms inspite of this large lesion. Intrauterine viral infection followed by calcification has been very well documented, but bacterial infection followed by calcification is very rarely reported. In literature only few cases of brain abscess with calcification is reported and pseudomonas brain abscess in infants has not been reported till now as per available literature, so we are reporting this rare case, from our institution. Auvichayapat et al 2 reviewed the clinical features and outcomes of treatments of 107 infants and children with brain abscesses. Congenital heart diseases and chronic otitis media were the most common predisposing factors. The common signs and symptoms were fever, headache, vomiting, alteration of consciousness, and focal neurologic deficit. The overall mortality rate was 10.7%. Calcified brain abcess in a 6 year old child reported by Kabre et al3. Pus culture showed staph

Post-traumatic growth, illness perceptions and coping in people with acquired brain injury

Post-traumatic growth is a process by which an individual who has faced a significantly adverse and life-altering event, can show evidence of an ability meaningfully to construe benefits from such adversity. The purpose of this study was to investigate, in a sample of people with acquired brain injury (ABI), the contribution of illness perceptions, distress, disability, and coping strategies and health to post-traumatic growth. Seventy people with an ABI took part in this cross-sectional investigation, comprising 70% males and 30% females. Traumatic brain injury accounted for the majority of brain injuries (56%), with 31% arising from a cerebrovascular accident and the remaining 13% arising from hypoxia, brain tumours, brain abcesses and encephalitis. The average time since injury was 70.43 months (SD = 55.30, range = 7–350). Participants completed assessments comprising post-traumatic growth (Post-traumatic Growth Inventory), beliefs about their condition (Illness Perception Questionnaire Revised), coping strategies (Brief COPE), anxiety and depression (Hospital Anxiety and Depression Scale) and functional disability (Functional Independence Measure and Functional Assessment Measure). All participants were accessing post-acute brain injury rehabilitation and support services. Results showed that greater levels of post-traumatic growth were associated with greater use of adaptive coping strategies (r=.597), lower levels of distress (r = –.241) and stronger beliefs about treatment-induced controllability of the effects arising from brain injury (r=.263). Greater use of adaptive coping strategies accounted for the greater proportion of the variance in post-traumatic growth (sr 2 = 0.287) and was the only variable found to make a unique and statistically significant contribution to the prediction of growth. Illness perceptions more generally were not significantly associated with growth experiences. This study provides additional evidence of the factors associated with the process of post-traumatic growth, in particular adaptive coping strategies that may help to facilitate growth, although the direction of this relationship requires further empirical investigation. The findings of this study may have implications for professionals providing neurorehabilitation services.

Brain abscess due to Nocardia cyriacigeorgica simulating an ischemic stroke

Nocardia spp. are bacteria often implicated in pulmonary diseases and central nervous system infections, especially in immunocompromised patients. We report here the case of an immunocompromised woman presenting an insidious brain abcess initially treated as a cerebral stroke. Despite a cotrimoxazole and rifampicin treatment she did not improve. She died 3 month later after she stopped her treatment.

PO07-MO-09 A case report of a 42-year-old Thai woman with multiple brain abcesses caused by Listeria monocytogenes

PO07-MO-09 A case report of a 42-year-old Thai woman with multiple brain abcesses caused by Listeria monocytogenes

50 Years Ago in The Journal of Pediatrics: Brain abcess in infants

50 Years Ago in The Journal of Pediatrics: Brain abcess in infants

Photodynamic therapy: a new antimicrobial approach to infectious disease?

Photodynamic therapy (PDT) employs a non-toxic dye, termed a photosensitizer (PS), and low intensity visible light which, in the presence of oxygen, combine to produce cytotoxic species. PDT has the advantage of dual selectivity, in that the PS can be targeted to its destination cell or tissue and, in addition, the illumination can be spatially directed to the lesion. PDT has previously been used to kill pathogenic microorganisms in vitro, but its use to treat infections in animal models or patients has not, as yet, been much developed. It is known that Gram-(-) bacteria are resistant to PDT with many commonly used PS that will readily lead to phototoxicity in Gram-(+) species, and that PS bearing a cationic charge or the use of agents that increase the permeability of the outer membrane will increase the efficacy of killing Gram-(-) organisms. All the available evidence suggests that multi-antibiotic resistant strains are as easily killed by PDT as naive strains, and that bacteria will not readily develop resistance to PDT. Treatment of localized infections with PDT requires selectivity of the PS for microbes over host cells, delivery of the PS into the infected area and the ability to effectively illuminate the lesion. Recently, there have been reports of PDT used to treat infections in selected animal models and some clinical trials: mainly for viral lesions, but also for acne, gastric infection by Helicobacter pylori and brain abcesses. Possible future clinical applications include infections in wounds and burns, rapidly spreading and intractable soft-tissue infections and abscesses, infections in body cavities such as the mouth, ear, nasal sinus, bladder and stomach, and surface infections of the cornea and skin.

Adli Otopsilerde Santral Sinir Sistemi Enfeksiyonu Saptanan Olguların Değerlendirilmesi

Amaç Çalışmada amacımız, retrospektif olarak santral sinir sistemi enfeksiyonlarının histopatolojik özelliklerini literatür bilgileri ışığında değerlendirmektir. Gereç- Yöntem 1998-2002 yıllarında Adli Tıp Kurumu Morg İhtisas Dairesinde otopsileri yapılan ve santral sinir sistemi enfeksiyonu saptanan 103 olgu çalışmaya alındı. Olgularımız yaş, cinsiyet, ölüm nedenleri (doğal ve travmaya bağlı ölümler) ve beyinde saptanan enfeksiyonun histopatolojik özellikleri açısmdan değerlendirildi. Bulgular Çalışmaya alman 103 olgunun %50,4’ü doğal, %49,6’sı travmaya bağlı gelişen komplikasyonlar sonucunda ölen olgulardı. Olgularımızın 85’i (%83,3) erkek, 18’i (%16,6) kadındı. Histopatolojik olarak, toplam 73 olguda (%70,87) menenjit saptandı. Bu grupta 60 olgu (%58,25) akut piyojenik (bakteryel) menenjit, 8 olgu (%7,76) akut aseptik (viral) menenjit, 5 olgu (%4,85) granülomatöz menenjit olarak değerlendirildi. Granülomatöz menenjit olgularından birinde (%20) beyin sapı tutulumuntın da eşlik ettiği nokardia enfeksiyonu, dördünde (%80) tüberküloz enfeksiyonu saptandı. 19 olguda (%18,44)ensefalit saptandı. Bu grupta 8 olgu nonspesifik ensefalit (%7,76), 5 olgu (%4,85) kuduza bağlı viral ensefalit, 1 olgu (%0,97) HlV’e bağlı ensefalit, 1 olgu (%0,97) progresif mültifokal lökoensefalopati, 4 olgu (%3,88) Prion hastalığı (Jacob-Creutzfeld) olarak değerlendirildi. Serimizde 3 olguda (%2,91) meningoensefalit , 6 olguda (%5,82) beyin absesi, 2 olguda da (% 1,94) non-spesifik serebrit tespit edildi. Sonuç Santral sinir sisteminde enfeksiyon hastalıklarının patolojisi oldukça karmaşık ve sıklıkla birbirleriyle örtüşen tabloları içermektedir. Sonuç olarak, enfeksiyon hastalıklarının patolojisinde mültidisipliner bir laboratuar araştırma yapılması gerekmektedir.Anahtar kelimeler: Santral sinir sistemi enfeksiyonları, otopsi

Two-day induction with thymoglobulin in kidney transplantation: risks and benefits

IntroductionThe aim of this study was to develop an induction protocol to reduce allograft rejection with fewer posttransplant infections and malignancies. MethodsIn this prospective randomized study, a T- and B-cell depletion protocol, consisting of IV thymoglobulin (ATG 5 mg/kg/d) plus methylprednisolone (500 mg/d) plus azathiopurine (2 mg/kg/d), was on days 0 and 1 after renal transplantation. CyA was introduced at day 3.39 among patients undergoing either primary living related (n = 16) or cadaveric (n = 23) transplants excluding recipients of full-HLA-matched sibling, or five- and six-HLA-matched cadaveric donor kidneys. The adequacy of immunosuppression was evaluated by flow cytometric analysis for total, CD3+ (T-cell), and CD19+ (B-cell) lymphocytes. ResultsThe acute rejection rate was 6% and 37/39 patients are alive with functioning grafts at an average follow-up of 14.5 months. The overall patient and graft survival rate was 95%. Their mean creatinine value was 1.27 mg/dL. Six patients (16%) required hospitalization due to serious infections. The two deaths were attributed to septicemia and brain abcess caused by unusual agents, namely, Rhodococcus equi and Sporobolomyces. One patient presented with a cutaneous Kaposi sarcoma in the 11th month posttransplant. ConclusionA Two-day induction protocol with thymoglobulin yields acceptable acute rejection rates among renal transplants. However, caution is necessary for adverse events, particularly atypical bacterial and fungal infections.

Permanent I Interstitial Radiation Therapy in the Treatment of Non-GBM High-Grade Gliomas

This study evaluates prognostic factors influencing survival outcomes for 50 patients with permanent125 iodine-125 implants in the primary treatment of non-GBM high-grade gliomas. Stereotactic treatment planning aimed to encompass the contrast-enhancing rim of the tumor visualized by CT, with an initial dose rate of 0.05 Gy/hour with 125I, delivering 100 Gy at 1 year and 103.68 Gy at infinity. Survival was evaluated using the Kaplan–Meier method for unvariate analysis and the Cox regressional method for multivariate analysis. In addition to the implant, 31 patients received external radiation therapy (5000 to 6000 cGy) before the implant; 10 patients were implanted without additional external beam radiation, and 9 patients underwent external radiation therapy before implant placement. With a mean follow-up of 40.76 months (range 3.47–87 months); 1−, 3−, and 5-year survival were 78.5% (± .05%), 58.7% (± .07%), and 56.2% (± .07%) respectively. Since 56.2% of the patients were alive at 5 years, median survival has not been reached yet. Second surgery was performed following the implant in 19 patients. Findings were tumor recurrence in 11 patients (22.5%), radiation necrosis in 7 patients (14.3%), and brain abcess in 1 patient (2%). Age, sex, tumor location, side of brain, tumor volume, Karnofsky, and neurological status were correlated with survival outcome. Favorable prognostic factors were age younger than 45 years, superficial tumor location, and preoperative Karnofsky greater than 70. Surgical treatment of patients with non-GBM high grade gliomas combined with external beam radiation and permanent 125I implants represent a valuable alternative for the treatment of patients with malignant gliomas, allowing patients good quality of life and long survival.

ACUTE FUNGAL EMBOLISM OF THE FEMORAL ARTERY

A 22-year-old woman who had been admitted to the department of psychiatry in our hospital with anorexia nervosa had a sudden onset of severe pain and cyanosis on her left lower extremity. She was referred to the department of surgery. Emergency angiography showed a complete obstruction of the left femoral artery. Embolectomy was performed according to the angiographic findings. Histological findings of this embolus revealed fungus embolus. After the operation, blood flow on her left lower extremity was recovered. Her consciousness level was, however, down suddenly in spite of intensive treatment. Twenty-seven days after the operation, she died of brain abcess. Infectious fungal endocarditis of mitral vulve was found by autopsy. These results suggest that acute fungal embolism was derived from infectious fungal endocarditis of the mitral vulve. Prognosis of systemic fungal infection is very poor and so we should examine the whole body and treat carefully.

Méningite à Streptococcus milleri avec dégagement gazeux intra-cérébral

We describe a case of purlent meningitis due to Streptococcus milleri (SM) associated with intra-cerebral pneumatocele. There was no evidence of neoplasic invasion, cranial trauma, anaerobic infection or brain abcess. Gas production has been previously reported in a case of septic arthritis related to SM, but never in menigitis.