Case Of Brain Abscess Research Articles

A study of 74 cases of brain Abscess

A study of 74 cases of brain Abscess

A study of 74 cases of brain Abscess

A study of 74 cases of brain Abscess

Clostridium glycolicum Isolated from a Patient with Otogenic Brain Abscesses

We describe a case of brain abscesses with gas formation following otitis media, for which the patient treated himself by placing clay in his ear. Several microorganisms, including Clostridium glycolicum, were cultured from material obtained from the patient. This is the first report of an infection in an immunocompetent patient associated with this microorganism.

Neurological practice in the Centuriae of Amatus Lusitanus

Amatus Lusitanus, a Portuguese Jew who gained notoriety as one of the most famous physician-scientists in XVI century Europe published collections of case histories--Centuriae--describing his most interesting patients. The Renaissance was a transitional period for medicine and the neurological sciences, which if still dominated by the humoral and ventricular-pneumatic doctrines, were taking the first steps away from them. We analysed the Centuriae for neurological and psychiatric cases in order to appreciate neurological practice in this period and selected one hundred which fit those diagnostic categories. The Centuriae contain cases of CNS infection and trauma, epilepsy, apoplexy and depressed states of consciousness (including coma, carus, lethargy and cataphora), headache and vertigo, tumours, cranial nerve paralysis, melancholy, anatomical and physiological observations, as well as a short treatise on cranial traumatology. The most relevant observations point to the importance of the brain parenchyma in cognition, provide original observations of epidemic lethargic encephalitis, describe the neurological consequences of syphilis, including the first description of tertiary syphilis, attempt to distinguish mania from melancholy, extensively describe medical and surgical treatment of cranial trauma, document the first use of anatomical dissection to study a case of brain abscess, negate Galen's view of the optic nerves as hollow, and describe the use of new drugs such as guaiac wood for the treatment of headache. The Centuriae not only provide insight into neurological clinical practice in the XVI century, but also emphasize the role of Amatus Lusitanus as an important precursor of this discipline, given his numerous original observations.

放射線性顎骨骨髄炎に起因したと疑われた脳膿瘍の１例

放射線性顎骨骨髄炎に起因したと疑われた脳膿瘍の１例

Multiple Brain Abscesses and Mastoiditis due to Morganella morganii After Chronic Otitis Media

Morganella morganii is a Gram-negative facultative anaerobic rod. It frequently causes urinary-tract and wound infections. We identify 4 M. morganii brain abscess cases previously reported in adults in the literature. This is the first case of multiple brain abscesses after mastoiditis secondary to chronic otitis media. The patient presented to an emergency service with fever, nausea, vomiting, headache, otalgia, and a tendency to sleep. Computerized tomography of the brain and temporal bone tomography scan demonstrated subdural abscesses in the frontal and parietal areas, parenchymal abscess in the temporal lobe, and mastoiditis. The abscesses were evacuated immediately with surgery and M. morganii was grown from the aspirate. The patient was treated with intravenous meropenem (3×2 g/d) and improved without neurologic sequelae.

ON THE REPORT OF THE FIRST SUCCESSFUL SURGICAL TREATMENT OF BRAIN ABSCESS IN THE OTTOMAN EMPIRE BY DR. CEMIL TOPUZLU IN 1891

IN 1891, Dr. Cemil Topuzlu operated on a brain abscess that originated as a complication of a depression fracture of the cranial inner table. The patient presented with Jacksonian seizures on his left side after a sharp trauma resulting in a 15 cm-long scalp laceration and underlying linear cranial fracture in the right parietal bone. Dr. Topuzlu attributed Jacksonian epilepsy to the fracture irritating the motor area in the right hemisphere and attempted a craniotomy based on his measurements to localize the Rolandic fissure. The operation was complicated by a brain abscess, and Dr. Topuzlu reoperated to drain the abscess. He successfully treated the brain abscess and Jacksonian seizures and then presented this case in the Royal Society of Medicine of the Ottoman Empire and in the International Surgery Congress in Lyon in 1894. The case report was published in his surgery book in 1905. The case was not only the first case of brain abscess to be treated successfully with surgical intervention in the Ottoman Empire, it was also one of the first cases of neurological surgery performed using contemporary anesthesiological and surgical techniques, which reveals the importance of neurological examination and cerebral localization techniques in the era before x-rays. Dr. Topuzlu was the founder of modern surgery in the Ottoman Empire and deserves to be credited for his novel applications in the 19th century.

Adult brain abscess associated with patent foramen ovale: a case report

Brain abscess results from local or metastatic septic spread to the brain. The primary infectious site is often undetected, more commonly so when it is distant. Unlike pediatric congenital heart disease, minor intracardiac right-to-left shunting due to patent foramen ovale has not been appreciated as a cause of brain abscess in adults. Here we present a case of brain abscess associated with a patent foramen ovale in a 53-year old man with dental-gingival sepsis treated in the intensive care unit. Based on this case and the relevant literature we suggest a link between a silent patent foramen ovale, paradoxic pathogen dissemination to the brain, and development of brain abscess.

Intracerebral Aspergilloma in an Immunocompetent Patient Resulting in Focal Seizure, Cranial Nerve Impairment, and Consecutive Hydrocephalus

Purpose: We would like to present a case of brain abscess caused by Aspergillus fumigatus in a 53-year-old immunocompetent male patient. He developed severe left-sided headache 5 months previously with diplopia. Clinical manifestations were mental depression, mild paresis of (left) recurrent nerve, numbness in the second and third divisions of CN V, tinnitus, and inner ear amblyacousia and left CN VI palsy. MRI characteristics aroused the suspicion of per continuitatem growing tumor in the left middle cerebral fossa.

Brain Abscess in Adult Cirrhotic Patients: Two Case Reports

Patients who have liver cirrhosis are at increased risk of bacterial infections, such as bacteremia, meningitis, pneumonia, urinary tract infections, and spontaneous bacterial peritonitis, due to immunodeficiency associated with the severity of the cirrhosis. Although bacterial infections are frequent in cirrhotic patients, only isolated cases of brain abscess have been reported. In these cirrhotic patients, the initial presentation of brain abscess may not be fever or leukocytosis, but focal neurologic deficits. In addition, for consideration of blood-brain barrier penetration, the anti-biotic choice postoperatively is also quite different from other infections outside the central nervous system. We will discuss two cases of brain abscess in cirrhotic patients with special emphasis on the clinical presentation, magnetic resonance spectroscopic findings, organism encountered, therapeutic strategy, and prognosis.

Retrospective analysis of 49 cases of brain abscess and review of the literature

The case records of 49 patients discharged from St George's Hospital, London, between December 2000 and March 2004 with the diagnosis of brain abscess were reviewed in order to document the epidemiology, causes, treatment, and prognostic factors associated with brain abscess. Brain abscess occurred at all ages, more frequently in men than in women. Headache and altered mental status were common presenting symptoms. The frontal lobe was the most common site. Streptococcal infection was seen most commonly, but staphylococcal infection predominated in cases following neurosurgery. Computed tomography provided sufficient diagnostic information in most cases. All but five patients had early surgical drainage. Cefotaxime and metronidazole were used most often for empirical therapy. Thirty-nine patients recovered fully or had minimal incapacity. Five patients died. Patients with underlying cranial neoplasms or medical conditions had a worse outcome than those with a contiguous focus of infection or post-traumatic abscess. Changes in disease pattern were determined by comparison to a literature review. A PubMed search of the literature using the keywords "brain abscess" was undertaken, and identified papers and relevant citations were reviewed. Compared to earlier series, there was a marked decrease in the number of cases of brain abscess secondary to otitis media and congenital heart disease. There was an increase in the number of cases of brain abscess secondary to neurosurgery and trauma. Changes in the epidemiology of predisposing conditions for brain abscess are associated with changes in the patient population and causative organisms. Though still a potentially fatal infection, there have been recent improvements in diagnosis, treatment, and outcome.

Brain abscess following intracerebral haemorrhage

We report two cases of brain abscess, which developed at the site of an intracerebral haemorrhage (ICH) in a 75-year-old man and a 32-year-old-man. The patients recovered after surgical treatment and systemic antibiotic therapy. The route of infection could not be detected in either case. The literature contains only 13 reported cases of brain abscess as a complication of ICH. Although the interval from initial ICH to abscess formation ranged from 4 to 20 weeks, almost all patients had episodes of high fever, indicating the presence of systemic infection and bacterial seeding, 0–14 days after the onset of their ICH. Therefore, abscess formation appears to be caused by haematogenous seeding of infection in patients with ICH. Abscess formation should be considered when a patient deteriorates clinically with a febrile episode after an ICH.

Unusual findings in cerebral abscess: report of two cases

Markedly restricted water diffusion is a characteristic of purulent fluid in brain abscesses. We report two cases of brain abscesses with unusual diffusion findings.

Otogenic brain abscess: management by otologist

Fifty per cent of brain abscesses in adults and 25 per cent of those in children are otogenic in origin. The current neurosurgical options are to drain the abscess repeatedly through burr holes or to excise it completely with the capsule. We successfully managed 10 cases of brain abscess by draining through the transmastoid route. The technique and its advantages are discussed. The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route. In eight cases, ear disease and brain abscess were treated in a single-stage procedure. In the remaining two cases, residual brain abscess was excised subsequently by our neurosurgical colleagues. Transmastoid drainage of pus can successfully treat mastoid disease and brain abscess in a single surgical intervention. Residual abscess can be subsequently excised, with relatively reduced morbidity. Repeated needling is also avoided with this approach. Diffusion-weighted imaging and proton magnetic resonance spectroscopy are helpful.

Conservative management of a brain abscess in a patient with Staphylococcus lugdunensis endocarditis

Brain abscess is defined as a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. Microorganisms can gain access to the brain through several mechanisms, most commonly by direct extension of an adjacent suppurative focus (i.e. otitis media, mastoiditis, or sinusitis) or by direct penetration via an open cerebrospinal fluid leak (e.g. after cranial fracture or neurosurgical complication). Another mechanism of brain abscess formation is hematogenous bacterial spread from a distant focus of infection, such as endocarditis. Despite the presence of continuous bacteremia, brain abscess is an uncommon complication after bacterial endocarditis [1] (less than 5% of cases in most series). However, endocarditis due to Staphylococcus lugdunensis follows a more fulminant course, typically resulting in either cardiac complications or systemic emboli with metastatic foci of infection. Optimal handling of patients with bacterial infections of the central nervous system often requires surgical management; nonetheless, a subset of patients may be treated with appropriate antimicrobial therapy alone [2–4]. In this setting, the choice of antibiotic agents should be based on the results of susceptibility testing and the drug’s cerebrospinal fluid penetration. Here, we report a case of brain abscess in a patient with S. lugdunensis endocarditis involving a native bicuspid aortic valve. We also review the literature regarding the conservative management of brain abscesses in this clinical setting. A 49-year-old woman with an unremarkable medical history was admitted to our hospital with fever of 39°C, right-sided hemiparesis and aphasia. Computed tomography (CT) scan of the brain suggested an ischemic lesion of the left external capsule. S. lugdunensis was isolated from all four of the blood cultures taken upon admission. The organism was shown to be susceptible to all antibiotics tested. A transesophageal echocardiograph (TEE) confirmed the presence of large vegetations (12×4 mm) on the bicuspid aortic valve and subsequent regurgitation due to aortic valve destruction. The diagnosis of endocarditis due to S. lugdunensis involving a bicuspid aortic valve with severe aortic valve insufficiency and embolic septic cerebrovascular insult was established. Antibiotic therapy with flucloxacillin (2 g iv q4h), supplemented with gentamicin (80 mg iv tid) for the first 5 days, was started. Body temperature, neurological deficiencies and inflammatory laboratory values normalized rapidly and the patient remained hemodynamically stable. After 6 weeks of antibiotic therapy, TEE showed persistent aortic valve vegetation and an increased diastolic diameter of the left ventricle (EDVI: 63 ml/m). Valve replacement was subsequently recommended. A second CT scan (Fig. 1) performed during the pre-operative investigation revealed the presence of a small abscess (1 cm in diameter) at the level of the left insula. Given the size of the abscess, the lack of neurological symptoms and the known tendency toward development of metastatic lesion secondary to S. lugdunensis bacteremia, surgical abscess excision was deferred. Because of its optimal ability to penetrate the blood brain barrier, rifampin (600 mg orally bid) was added to the antibiotic regimen. Eur J Clin Microbiol Infect Dis (2006) 25:476–478 DOI 10.1007/s10096-006-0169-0

Zoonoses: A Case Presentation

ISSUE: Certain bacteria can cause disease in animals as well as humans. In some cases the bacteria is transmitted from the animal to the human. A case of Rhodococcus equine brain abscess was identified in a 26 year old intravenous drug user with exposure to horses.Once thought to be exclusively an equine pathogen, Rhodococcus equine infection is occuring in humans with an increasing frequency. It has been found in immunocompromised individuals including those with AIDS, small cell lung carcinoma, lymphoma, or lung and bone marrow transplant recipients. Very little is known about the pathogenesis of the disease except for its mode of transmission which is almost always via the droplet/ respiratory route. PROJECT: A patient was admitted to the hospital with the diagnosis of sinus infection. Her presenting signs and symptoms were right sided weakness, headache, and facial droop. Her mental status progressively declined. Lab studies included a negative HIV test and a CD4 count of 813. A CT of the brain revealed a thalamic brain lesion. Since the differential diagnosis included an infectious process the patient was empirically started on Vancomycin, Ceftriaxone, Metronidazole, Bactrim, Amphotericin B, and Acyclovir. A brain biopsy was performed on hospital day 60. RESULTS: On hospital day 64 brain tissue grew Rhodococcus equine, a bacteria that causes disease in horses. Upon further questioning of the patient's family a possible link was found. The family stated that the patient was known to inject herself with needles previously used on horses. LESSONS LEARNED: Although many zoonotic diseases have been reported this is believed to be the first case of brain abscess caused by Rhodococcus equine. A zoonotic disease should be considered in the differential diagnosis of any patient that works closely with animals. A thorough history is important. The patient's exposure to horses and her intravenous drug use were known, however more intense questioning may have yielded critical information about her injection practices. Clinical correlation is important so as not to disregard a culture result as a contaminant. In this era of bioterrorism it is important to consult with the state and national authorities to determine if an unusual organism has been earmarked as a potential agent of bioterrorism. As of this time Rhodococcus equine is not. When a brain biopsy of unknown etiology is performed consideration should be given to handling the instruments using a protocol for suspected prion disease.

Brain abscess due to Aspergillus nidulans

Invasive aspergillosis of the central nervous system commonly occurs in immunocompromised patients. In recent years with increased awareness and improved imaging techniques, central nervous system infections have also been described in immunocompetent patients. We present a case of brain abscess caused by Aspergillus nidulans in a 14-month-old male baby without any underlying defects. To our knowledge, the present case represents the third known case of A. nidulans causing brain abscess in a child without any known immuno-suppression.

Brain Abscess After Tonsillectomy

The authors report a case of brain abscess after a tonsillectomy. A 25-year-old man developed headache and dysphasia a few days after a tonsillectomy. A brain abscess was diagnosed and managed. This is a rare complication of a tonsillectomy, especially after the introduction of antibiotics, but it still occurs.

Clinical Analysis of 27 Cases of Brain Abscess

Clinical Analysis of 27 Cases of Brain Abscess

Absceso cerebral infantil

Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003.We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome.Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae.Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed.