Cerebellar Abscess Research Articles

Intracranial Abscess Due to Disseminated Aspergillosis in a Renal Transplant Recipient - A Case Report

Fungal infections have devastating consequences in a renal transplant recipient. The risk of mortality is high despite early diagnosis and appropriate therapy. Here, we report the case of a 62-year-old male with multiple comorbidities who developed a deep-seated cerebellar abscess due to disseminated aspergillosis. Neuroimaging features and galactomannan features were critical in aiding the diagnosis as the abscess was difficult to access surgically. Early institution of appropriate antifungal therapy along with reduction in immunosuppressive medications helped in the successful treatment of a surgically difficult to access cerebellar abscess.

Pseudomonas Pseudoalcaligenes Caused Otogenic Cerebellar Brain Abscess In Indonesian Child

Otogenic brain abscess is a common intracranial complication from chronic supurative otitis media.Pseudomonas pseudoalcaligenes is a rare cause of brain abscess. Prompt diagnosis and decision making issignificant in order to decrease the mortality rate from this type of abscess. We described A 13-year-old boypresented with decreased consciousness, positive meningeal signs, and pathological reflexes. There was ahistory of chronic suppurative otitis media. A head CT scan revealed multiple left cerebellar abscesses andbrain edema. The abscess wall culture revealed P. pseudoalcaligenes. After being managed with surgicalabscess drainage, mastoidectomy, ear flushing, and antimicrobial therapy for six weeks, his consciousnesslevel improved. Cerebellar neurological impairment was still observed. Physical and neurologicalrehabilitation was performed in order to improve the patient’s condition.

Intracranial Nocardiosis a Rare Condition: A Case Report

Cerebral Nocardiosis is a rare, challenging, opportunistic infectious disease of the central nervous system occurring in both immunocompetent and immunocompromised hosts. It often results in intraparenchymal abscess formation, which represents only 2% of all cerebral abscesses. The diagnosis of cerebral Nocardiosis is seldom based on imaging. Bacteriological diagnosis is often reached only after surgical excision of the abscess. We herewith reports 37 yr old patient with cerebellar abscess which grew nocardia.

Intracranial and extracranial complications of chronic otitis media and their management at a tertiary care center: a descriptive study

<p><strong>Background: </strong>In the pre-antibiotic era complications from otitis media occurred abundantly, accompanied by high morbidity and mortality. With availability of higher antibiotics, morbidity and mortality due to chronic otitis media (COM) has reduced, but still complications due to COM remain a significant problem in developing countries. The aim is to study clinical presentation, management and outcomes of intracranial and extracranial complications of COM. Study design is retrospective case series study.</p><p><strong>Methods:</strong> Patients admitted in department of otorhinolaryngology and head and neck surgery, S. Nijalingappa medical college and H.S.K hospital and research center, Bagalkot from May 2018 to April 2020 with COM associated with intracranial or extracranial complications were included in the study. Data of clinical presentation, associated complications, management, and follow-up were analyzed.</p><p><strong>Results:</strong> A total of 20 patients were reviewed during study period. Of these seventeen patients had extracranial (EC) complications, while one had intracranial (IC) complications and two had both. Otalgia, otorrhea and fever were the main presenting symptoms. The encountered IC complication were lateral sinus thrombophlebitis, cerebellar abscess. Among the EC complications most common were post-auricular subperiosteal abscess, lateral semicircular canal fistula and facial paralysis. Most commonly isolated organism was staphylococcus. Surgery was main modality of treatment.</p><p><strong>Conclusions:</strong> COM is still a significant problem in developing countries in spite of availability of antibiotics and early diagnosis is crucial in the management of complications associated. This study emphasizes the importance of early diagnosis and prompt treatment to limit the morbidity.</p>

Safety and Accuracy of Ultrasound-guided Burr Hole Brain Abscess Aspiration.

Ultrasound-guided burr hole biopsies or catheter placements are quick and safe procedures. The use of these procedures for treatment of brain abscesses has been reported, but larger series are missing. The aim of our study was to evaluate the accuracy and safety of the methods. Twenty-five brain abscess aspirations in 17 patients were analyzed. Fourteen procedures were performed to evacuate abscesses in eloquent regions; another 3 were located deeply in the cerebellar hemispheres. In all the procedures, a histopathologic diagnosis could be established. Only one transient deterioration of a hemiparesis occurred; other operative complications were not observed. Six patients needed more than one operation due to a relapse of the abscess. Two out of three cerebellar abscesses could be cured with one aspiration. Thirteen patients had an excellent outcome, and 2 remained severely disabled. One patient died from cerebritis and another from a neoplasm. In every procedure, a proper visualization of the abscess and monitoring of the penetration and aspiration could easily be performed. Ultrasound-guided burr hole aspiration is minimally invasive, quick, and has a very low complication rate. It offers the advantage to adapt to intraoperatively changing anatomy. The rate of recurrence is not lower than in other treatment modalities.

NOCARDIOSIS PRESENTING LIKE A METASTATIC LUNG CANCER

SESSION TITLE: Medical Student/Resident Lung Pathology SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Nocardia is a gram-positive, weakly acid-fast, branching rod which is ubiquitous environmental saprophytes that cause localized or disseminated disease in both immunocompetent and immunocompromised patients. We present here a case of a 55-year-old male who was found to have right middle lobe lung abscess as well as right cerebellar abscess secondary to disseminated Nocardiosis from the pulmonary source. CASE PRESENTATION: A 55-year-old male with a past medical history of hypertension, hyperlipidemia, migraines, 30 pack-year smoking history, and emphysematous COPD presented to the hospital with 5 days of cough productive of clear sputum, headache and multiple episodes of emesis. He also reported 30 pounds weight loss over the last 1 year due to poor appetite. On presentation, he was hypoxic and tachypneic requiring 5 liters of oxygen by nasal cannula. Physical examination showed a cachectic male with decreased breath sounds bilaterally and crackles in the right lower lung field. The neurological exam showed nystagmus with right-sided gaze and square wave jerks as well as dysdiadochokinesia. Labs showed elevated WBC count at 17.6*10^3 with Neutrophilic pleocytosis. Chest CT showed right middle lobe lung mass, multiple bilateral pulmonary nodules as well as right lower lobe pneumonia. CT head showed right-sided cerebellar mass. Hence an emergent MRI was obtained to assess the mass which showed a large multiseptated cerebellar mass measuring 4.7 * 5.8 * 3.2 cm with mild vasogenic edema centered in the right cerebellar hemisphere crossing midline and producing severe stenosis of the fourth ventricle and resultant obstructive hydrocephalus. The patient was taken to the Operating room STAT and when the right cerebellum was entered a green-tinged fluid started draining which was sent for a culture that grew Nocardia cyriacigeorgica. The patient also had a bronchoscopic biopsy of the right-sided lung mass a day later which also grew the same organism. The patient was initially treated with Intravenous vancomycin, ceftriaxone and levofloxacin for broad-spectrum coverage for pneumonia and after the cultures grew Nocardia was switched to intravenous trimethoprim-sulfamethoxazole and meropenem after infectious disease consultation. However, he failed to respond to the therapy and was made comfort care and passed away. DISCUSSION: Disseminated disease with Nocardia involving brain and lung has been reported in both immunocompromised and immunocompetent patients. However, most of the cases reported in the literature are of elderly patients or immunocompromised patients. As the population of the United States is aging with many patients on immunomodulators it is imperative to raise awareness about disseminated nocardiosis CONCLUSIONS: Physicians must be aware that disseminated nocardiosis can mimic the presentation of metastatic lung carcinoma: early surgical intervention in brain abscess improves outcomes. Reference #1: Karan M, Vučković N, Vuleković P, Rotim A, Lasica N, Rasulić L. Acta Clin Croat. 2019 Sep;58(3):540-545. doi: 10.20471/acc.2019.58.03.20. Reference #2: Schlaberg R, Huard RC, Della-Latta P. Nocardia cyriacigeorgica, an emerging pathogen in the United States. J Clin Microbiol. 2008. Jan;46(1):265–73. 10.1128/JCM.00937-07 Reference #3: Lee GY, Daniel RT, Brophy BP, Reilly PL. Surgical treatment of nocardial brain abscesses. Neurosurgery. 2002. Sep;51(3):668–71, discussion 671–2. 10.1097/00006123-200209000-00010 DISCLOSURES: No relevant relationships by Fazal Raziq, source=Web Response No relevant relationships by Muhammad Usama, source=Web Response

Our experience on the management of acute mastoiditis in pediatric acute otitis media patients

ObjectiveThe incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition. MethodsChildren hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups. ResultsOf the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001). ConclusionAM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.

Extensive Cholesteatomas: Presentation, Complications and Management Strategy.

To document the clinical presentation, complications, management strategy and post-operative outcomes of extensive cholesteatomas. Cholesteatoma is a well demarcated cystic lesion derived from an abnormal growth of keratinizing squamous epithelium in the temporal bone. Cholesteatomas commonly involve the middle ear, epitympanum, mastoid antrum and air cells and can remain within these confines for a considerable period. Bony erosion is present confined to ossicular chain and scutum initially, but as the cholesteatoma expands, erosion of the otic capsule, fallopian canal and tegmen can occur. Erosion of the tegmen tymapani or tegmen mastoideum may lead to development of a brain hernia or cerebrospinal fluid leakage. Invasion of jugular bulb, sigmoid sinus, internal carotid artery are noticed in extensive cholesteatoma and are quite challenging and requires expertise. Neurosurgical intervention should be considered along with the otological management in the same sitting in all possible cases. A retrospective review of 12 patients were carried out to assess the clinical presentation, complications, surgical management and postoperative outcomes of extensive cholesteatomas presenting at our centre between January 2017 and December 2019. CT or MRI findings, extent of cholesteatoma intra-operatively along with the status of major neurovascular structures and disease clearance, and the post-operative outcomes including morbidity and mortality were noted. All patients underwent canal wall down mastoidectomy with or without ossiculoplasty. Post operatively all patients were treated with intravenous antibiotics and if required intravenous steroids. Amongst the 12 patients of extensive cholesteatoma (EC), all of them (100%) presented with foul smelling, purulent ear discharge. 9 (75%) patients presented with otalgia. 4 (33.33%) patients had temporal headache. 10 (83.33%) patients complained of hard of hearing. 7 (58.33%) patients gives history of vertigo at the time of presentation. In 8 (66.66%) patients there was tegmen plate erosion noticed in CT scan. In 3 (25%) patients, the disease was invading the sigmoid sinus and in 1 (8.33%) patient jugular bulb was involved. In 3 (25%) cases of EC, blind sac closure was performed. In two patients who developed cerebellar abscess, drainage procedure was performed. 2 (16.66%) patients developed sigmoid sinus thrombosis, 1 (8.33%) patient had petrositis.

Neuropathological Findings in Ephedrone Encephalopathy

A number of cases of severe parkinsonism-dystonia have been recognized and reported following the illicit use of ephedrone prepared from pseudoephedrine and potassium permanganate. The pathology associated with ephedrone neurotoxicity has not been described yet in the scientific literature. To report the first neuropathological study of ephedrone toxicity. The brain of a 33-year-old Ukrainian female ex-ephedrone addict with a long history of l-dopa-unresponsive parkinsonism with dysarthria, dystonia, profound postural instability, cock-gait, and frequent falls, and on antiretroviral treatment, was examined using routine stains and immunohistochemistry. Neuropathological findings included diffuse pallidal astrogliosis without neuronal depletion. There was also widespread vascular pathology with small vessels occluded by foreign material, associated with giant cell response without any evidence of consequent focal infarction and a cerebellar abscess. Clinical findings of l-dopa-unresponsive parkinsonism with dystonia, caused by illicit use of ephedrone, are fully consistent with neuropathological changes in the pallidum, lack of change in the SN, and preserved tyrosine hydroxylase activity. The findings in the basal ganglia are compatible with manganese toxicity. The vascular pathology is likely a joint effect of infection and the ephedrone toxicity on the vessels. © 2020 International Parkinson and Movement Disorder Society.

Labyrinthine Fistula-Our Experience at a Tertiary Hospital.

This study has aimed to determine the anatomical site of labyrinthine fistula in patients of chronic suppurative otitis media at our centre. Labyrinthine fistulae (LF) are caused by abnormal communications between the inner ear and surrounding structuresresulting in perilymph leakage and hearing loss. Labyrinthine fistula represents as erosive loss of the enchondral bone overlying the semicircular canals without loss of perilymph. The manifestations of fistula like vertigo, hearing loss vary in severity and complexity, commonly ranging from very mild to incapacitating. Cholesteatoma induced fistula most commonly involves lateral semicircular canal probably because of its close proximity to the middle ear, but can involve other semicircular canals and rarely cochlea. This is a retrospective analysis of 36 patients of chronic suppurative otitis media with history of vertigo undergoing tympanomastoid surgery in whom there was an evidence of labyrinthine fistula on HRCT scan of temporal bone. The incidence of patients with labyrinthine fistula presenting with vertigo, nystagmus, sensorineural hearing loss, history of vertigo were analysed. The anatomical location of the fistula was supported by Radiological evidence. Patients underwent either canal wall down mastoidectomy or cortical mastoidectomy. The anatomical site and length of the labyrinthine fistula were analysed. Amongst the 36 patients of chronic suppurative otitis media with labyrinthine fistula 22 (61.1%) patients had atticoantral disease, 4 (11.1%) patients had chronic otitis media with extensive granulation, 2 (5.5%) patients had Tubotympanic disease with polyps, 4 (11.1%) patients had Tuberculous otitis media, 1 (2.77%) patient had Tubotympanic disease with extensive tympanosclerosis eroding the dome of lateral semicircular canal, 1 (2.77%) patient had extensive cholesteatoma with cerebellar abscess, 1 (2.77%) patient had fistula in the promontory following trauma, 1 (2.77%) patient had extensive tympanosclerosis with erosion of promontory. It was noticed that, in 14 (38.88%) patients the fistula was at the centre, in 17 (47.22%) patients the fistula is towards the ampullary end of horizontal semicircular canal and in 5 (13.88%) patients the fistula was towards the non ampullary end of lateral semicircular canal. The maximum length of fistula noticed was 6mm and the minimum length of the fistula noticed was 2mm. Labyrinthine fistula are most commonly noticed in the ampullary end of the lateral semicircular canal. The average length of the fistula was found to be 4mm. Careful elevation of the cholesteatoma matrix over the endosteal membrane and immediate placement of temporal fascia over the exposed fistula is important to avoid injury to the inner ear. Maximum number of fistula were seen in the atticoantral type of Chronic suppurative otitis media. Prior knowledge of anatomical location of the fistulous tract in HRCT temporal bone is important to address the fistula.

Occipitocervical fusion complicated with cerebellar abscess: a case report

BackgroundOccipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure.Case presentationWe described a patient who underwent OC fusion and subsequently developed complication of cerebellar abscess and obstructive hydrocephalus. A 63-year-old male patient had been suffering from long-term neck pain and limb numbness and weakness. Cervical spine examination revealed tight stenosis at C1 level and instability in the C1-C2 joints. A C1 laminectomy with OC fusion was performed, and the patient was discharged. Unfortunately, a few days later, he went to the emergency department and complained of persistent dizziness, vomiting, and unsteady gait. Computed tomography (CT) and magnetic resonance imaging (MRI) images revealed a suspicious cerebellar abscess formation and hydrocephalus. Furthermore, CT images indicated that the left screw was loose, and the diameter of the right screw hole was much larger than the size of the screw. Besides, inappropriate length of the screw penetrated the occipital bone and may cause the disruption of dura mater. The patient underwent external ventricular drainage first, followed by abscess drainage and C1-C2 fixation a few days later. He was discharged without any further neurological deficits or infectious problems. The patient recovered with intact consciousness, full muscle strength, and improved numbness throughout the extremities, with a Nurick grade of 1. A follow-up magnetic resonance imaging at 3 months after surgery revealed near total resolution of the abscess. Inform consent was obtained from this patient.ConclusionsCarefully conducting the procedure using the most tailored approach is essential to successful surgery, but this rare complication should always be kept in mind.

Stapes fixation to the promontory and fallopian canal in a case of chronic otitis media: Implications on development and etiology

Embryology of stapes has long been a topic of controversy. There are theories stating a single source to the dual origin of stapes. Chronic otitis media is also known to cause various acquired bony ossicular fixations. We present a case of an 11-year-old female with right chronic otitis media, active squamosal with cerebellar abscess who underwent drainage of cerebellar abscess followed by tympanomastoidectomy as a two-staged procedure. Intraoperatively, there were stapes suprastructure fusion to the fallopian canal and one crural attachment to the promontory. There are no clear criteria to differentiate bony fixation of congenital origin from acquired causes. This case also highlights the need to add a new subclass in the classification of minor middle ear anomalies given by Cremer, and our findings also support the dual origin for stapes development.

Cerebellar abscess secondary to extradural internal protuberance epidermal cyst

An Intracranial epidermoid cyst is a rare congenital anomaly developed because of dysembryoplasia during the third to fifth week of gestation. We describe the unusual epidermal cyst which originating extradurally in internal protuberance in which causes cerebellar brain abscess. Neurosurgical intervention is advocated to prevent the ongoing risk of significant complications. Meticulous care was taken to grossly excised all the pathologic tissue to avoid recurrence.

Microbial profile of ear discharge in children with chronic suppurative otitis media and the antibiotic susceptibility pattern of bacterial isolates

Microbial profile of ear discharge in children with chronic suppurative otitis media and the antibiotic susceptibility pattern of bacterial isolates - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.038, Indian Journal of Microbiology Research-Indian J Microbiol Res

Recurrent cerebellar abscess secondary to cranial dermal sinus associated with dermoid cyst in children

Background: Posterior fossa dermoid cysts are rare, benign lesions whose diagnosis can be quite challenging because of their slow growth and subsequent paucity of symptoms. We present herein an unusual case of recurrent cerebellar abscesses induced by an adjacent extradural dermoid cyst with a complete occipital dermal sinus. Methods: The authors report the case of a 20-month-old girl who presented with signs of acutely raised intracranial pressure and whose head scans showed a left cerebellar hemisphere abscess associated with obstructive hydrocephalus. The patient was treated initially with an external ventricular drain, followed by burr-hole aspiration of the abscess and long-term antibiotics. Since the cerebellar abscess recurred, a posterior fossa craniotomy was performed and gross total resection of the lesion along with the dermal sinus tract and abscess contents was achieved. Histopathological analysis confirmed a dermoid tumor. Conclusions: The occurrence of recurrent cerebellar abscesses must always rise up the suspicion of an associated dermoid cyst. Neuroradiological scans should be carefully evaluated in search for this lesion. Once the diagnosis is established, radical resection of the cyst, sinus tract and infectious components is the treatment of choice.

Nocardia paucivorans cerebellar abscess: Surgical and pharmacotherapy

Background:Nocardia species are ubiquitous in nature and mainly cause pulmonary disease in humans; however, they can also infect the central nervous system and skin. The management of cerebellar nocardiosis is troublesome and requires multiple considerations of the severity of the underlying systemic disease, difficulties in identifying the bacterium, and frequent delay in initiating adequate therapy.Case Description:We report a 52-year-old diabetic female patient with Nocardia paucivorans cerebellar abscesses. Brain magnetic resonance imaging (MRI) revealed innumerable small ring-enhancing lesions of posterior fossa. In this report, we present a case of primary single cerebellar abscesses due to N. paucivorans. Early diagnosis and surgical interventions were significant for the patient. The diagnosis was confirmed by DNA sequencing and the organism was susceptible to trimethoprim–sulfamethoxazole (TMP/SMX). The patient was successfully treated with drugs and surgical excision.Conclusion:According to the literature, surgical excision or aspiration of cerebellar abscess seems to provide favorable outcomes. In our experience, a successful outcome was achieved with subtotal resection and prolonged adequate antibiotic therapy.

Kronik Otitis Medianın Ciddi ve Nadir Komplikasyonu Olrak Serebellar Apse

Kronik Otitis Medianın Ciddi ve Nadir Komplikasyonu Olrak Serebellar Apse

Isolated Cerebellar Abscess by Burkholderia pseudomallei in an Immunocompromised Host: A Rare Case

Isolated Cerebellar Abscess by Burkholderia pseudomallei in an Immunocompromised Host: A Rare Case

Cerebellar Abscess Caused by Extension of an Otogenic Infection Through the Labyrinth and Internal Auditory Canal.

Cerebellar Abscess Caused by Extension of an Otogenic Infection Through the Labyrinth and Internal Auditory Canal.

Suspected exaggerated reaction to dopamine infusion in a cat with increased intracranial pressure

An 11-year 8-month-old, male, neutered domestic shorthair cat was presented for investigation of progressive right vestibular signs following recent ear canal surgery. The investigations showed otitis media/interna, intracranial empyema and...