Cranial Abscess Research Articles

Scalp and Dural Reconstruction With a Tensor Fascia Lata Myofascial and Anterolateral Thigh Fasciocutaneous Chimeric Flap: A Case Report

Composite scalp and cranial defects present a challenge due to the unique elements that need to be reconstructed. The goals of reconstruction are to protect intracranial contents, prevent cerebrospinal fluid leak (CSF) and infection, and to provide durable soft tissue coverage. We present a case of an immunocompromised patient with history of craniotomy who developed osteomyelitis and a cranial abscess resulting in a composite defect with dural, bony, and soft tissue loss. To achieve vascularized watertight dural repair and durable soft tissue coverage for resolution of infection and eventual staged cranioplasty, we performed a free tensor fascia lata (TFL) myofascial and anterolateral thigh (ALT) fasciocutaneous chimeric flap. The patient healed well without CSF leak or infection at 5-month follow-up and cranioplasty is planned. Use of a chimeric TFL and ALT flap is effective in the treatment of large, composite cranial defects in the setting of active infection.

Facts about Wildlife Diseases: Antler Infections and Cranial Abscess Disease in White-Tailed Deer

This article provides valuable insights into antler infections and cranial abscess disease in white-tailed deer. It emphasizes the importance of addressing these concerns for the species’ conservation and well-being. Written by Michael A. Lyons, Amira M. Richardson, Merrie P. Urban, and Juan M. Campos Krauer, and published by the Veterinary Medicine—Department of Large Animal Clinical Sciences, UF/IFAS Extension, January 2024.

Cerebellar tuberculoma in an immunocompetent patient

Background: Tuberculosis infection of the Central Nervous System is the major cause of death and morbidity in developing countries. The clinical manifestations and radiological findings in tuberculoma are nonspecific. This article reports a rare case of cerebellar tuberculoma with the manifestation related to an intracranial mass and without the typical clinical symptoms of Tuberculosis in an immunocompetent patient. Case Report: A 20-year-old female with seizure, headache, and vertigo. A mass in the posterior fossa was revealed by Magnetic Resonance Imaging. Thorax scan results showed the Tuberculosis process. The patient then underwent surgery. Histopathological examination displayed chronic granulomatous inflammation and the presence of Acid-Fast Bacilli. The patient received anti-tuberculous drug treatment for one year and anti-seizure medication. Discussion: Cerebellar tuberculoma can resemble an intracranial tumor or cranial abscess. Diagnosis is based on clinical, radiological manifestations, and histopathological analysis. Surgical intervention still has a role in the treatment of this disease. The finding of Mycobacterium tuberculosis on histopathological examination is the gold standard in diagnosing Tuberculosis. Conclusions: Although it is rare, the involvement of Tuberculosis in the CNS should be taken into account in both immunocompetent and immunocompromised patients with neurological symptoms who are living in an endemic area.

First Description of a Mandibular Brodie Abscess in a Pediatric Patient: Case Report

Brodie abscesses can be considered to be a very rare condition, especially in pediatric patients. In 2019, the first cranial Brodie abscess was published in a 51-year-old female following a dental procedure. In this article, we present our case of a 13-year-old boy suffering from recurrent, painless swelling in the left mandibular molar region. MRI, CT, and histopathological examination revealed the diagnosis of a Brodie abscess. During the clinical course, several other differential diagnoses had to be excluded by CT, MRI, and histopathological examination, as a Brodie abscess was the by far least likely diagnosis. As no standard treatment protocols were available, we conducted a profound review of the current literature and the different therapeutic approaches described. The condition was subsequently treated by enucleation and implantation of a gentamicin-impregnated collagen sponge, accompanied by the administration of long-term oral antibiotics. In our postoperative aftercare, there was no clinical or radiological evidence for recurrence.

Brain Abscess and Esophageal Dilatation: Where is the Link? - Case Report

Abstract Introduction Caustic substance ingestion is a common cause of esophageal stricture in children. The primary treatment is esophageal dilatation. Although it is known that endoscopic esophageal dilatation is a procedure associated with a high rate of bacteremia, current guidelines do not recommend routine throat swab cultures or antibiotic prophylaxis for the general children population. Case Report We describe a case of a 7-year-old boy presenting with refractory headaches who was diagnosed with cranial abscess after multiple esophageal dilatations due to stenosis caused by caustic soda ingestion. The patient was subjected to neurosurgical intervention and intravenous antibiotic treatment for 6 weeks. Streptococcus viridans culture was positive in purulent abscess content. Conclusion We highlight this condition that, although rare, needs immediate diagnosis and proper treatment. We also recommend routine testing of throat swabs and antibiotics prophylaxis to children undergoing esophageal dilatation.

Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature.

Central nervous system (CNS) infections are significant causes of morbidities and mortalities in children with some being prone to the development of abscesses which can either be within the brain parenchyma or located in extracranial structures. We aimed to describe the clinical profile and outcome of children with cranial abscesses at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). Consecutive cases presenting at the Children Emergency Ward of OAUTHC Ile-Ife were recruited. The pattern of presentation, predisposing factors and outcome of these children were studied. Among the 641 children admitted within a 6-month period, six were diagnosed with cranial abscess giving a hospital prevalence of 0.9%. The mean duration of symptom prior to presentation was 12.7 ± 13.4days. Five (83.3%) of the patients had intracranial abscesses which were multiple in two (33.3%) children. One patient had Pott's puffy tumour following frontal sinusitis. Surgical management was done for two (33.3%), and this was by craniotomy and evacuation. Two of the patients died with a case fatality rate of 33.3%. Though uncommon, cranial abscesses remain life threatening in children especially in resource-poor settings. Early presentation and early treatment of local infections will improve outcome.

Challenges in Microsurgical Reconstruction for Craniofacial Osteomyelitis With Resultant Osteonecrosis.

Chronic osteomyelitis is characterized by compromised blood supply and eventual osteonecrosis. Definitive treatment requires aggressive resection of affected bone. The resultant defect poses a unique challenge to reconstructive surgeons. Much of the literature on craniofacial osteomyelitis focuses on infection eradication, rather than subsequent reconstruction. This article reports representative cases from our experience with free flap reconstruction for defects secondary to chronic osteomyelitis of the craniofacial skeleton. The authors selected 5 of the most difficult reconstructive cases of craniofacial osteomyelitis from our experience in a single tertiary referral institution with a follow-up of at least 6 months. Three of the 5 cases arose in the setting of previous head and neck cancer treated with resection and radiation therapy. One case had a previous surgical craniotomy complicated by osteomyelitis and multiple failed alloplastic reconstructions. The final case was due to multiple gunshots to the head, with subsequent cerebral and cranial abscess (>1000cc). In each case, the defect was successfully treated with free tissue transfer. Two cases required creation of recipient vessels with an arteriovenous loop. Free tissue transfer provides a versatile and effective tool in the reconstruction of extensive craniofacial osteomyelitis defects. Furthermore, the addition of vascularized tissue can protect against further episodes of osteomyelitis. Finally, arteriovenous loops can be employed successfully when prior radiation and infection of the wound bed precludes the use of local recipient target vessels.

The Use of Halo Gravity Traction in the Treatment of Severe Early Onset Spinal Deformity.

Retrospective Review of Prospective cohort. To describe the feasibility of preoperative halo gravity traction (HGT) with subsequent growing rod/guided growth (GR/GG) placement in early onset spinal deformity (EOSD). In children with severe EOSD, primary implantation of GR/GG constructs is not always possible. We describe a staged protocol with preoperative HGT followed by GR/GG implantation. EOSD patients treated with HGT prior to GR/GG implantation were included. HGT used traction up to 50% body weight for 4 to 29 weeks. Pulmonary function tests (PFTs) were performed before and after HGT. Coronal Cobb (CC) and Sagittal Cobb (SC) angles were measured on the Pre-HGT, Post-HGT and 6 week postop x-rays. Thirty patients were included. Average age at GR/GG implantation was 9 years. Most cases (n = 24, 80%) were idiopathic. Most pts had kyphoscoliosis (n = 16, 53.3%). Pre-HGT CC averaged 112 ± 22° and SC averaged 106 ± 26°. CC and SC improved 29% after HGT. There was a significant improvement in body mass index following HGT. CC improved further to 70 ± 14° (36% vs. pre-HGT) and SC to 63 ± 21° (41%) with GR/GG placement. HGT-related complications occurred in nine patients (30%); eight pin site infections, one cranial abscess. Most HGT complications were managed with local pin care and oral antibiotics. Halo revision was required in two pts (6.7%). There was no change in PFTs with HGT (P > 0.05). Averagely, 14 levels were spanned during GR/GG implantation; two patients required vertebral column resection. Surgical complications occurred in nine (30%) patients. At average 16 month follow-up, seven patients (23.3%) required reoperation. Preoperative HGT can make severe EOSD curves amenable to GR/GG implantation. HGT results in ∼30% correction with improvement to ∼35-40% following GR/GG. HGT has a 30% complication rate but most are pin-site infections managed with pin-site care and oral antibiotics; 6.7% of patients require revision. 4.

A HEADACHE FROM OUR PAST? INTRACRANIAL ABSCESS DISEASE, VIRULENCE FACTORS OF TRUEPERELLA PYOGENES, AND A LEGACY OF TRANSLOCATING WHITE-TAILED DEER ( ODOCOILEUS VIRGINIANUS).

Trueperella pyogenes, a bacterial opportunistic pathogen residing along the skin layer of apparently healthy animals, is the etiologic agent of intracranial abscessation-suppurative meningoencephalitis, a cause of mortality for male white-tailed deer ( Odocoileus virginianus). Occurrence of this disease has been speculated to be influenced by virulence of T. pyogenes residing on white-tailed deer in geographically distinct metapopulations. To determine if differences in virulence potential of T. pyogenes could affect occurrence of disease across populations, we examined if frequency of seven virulence genes of T. pyogenes from forehead swabs of 186 apparently healthy white-tailed deer differed between sites in the state of Georgia, US, where ≥1 male tested positive for a cranial abscess and sites where no individuals tested positive for a cranial abscess. We detected six of seven virulence genes more frequently at sites where we detected ≥1 male with a cranial abscess compared to sites where we did not detect any individuals with a cranial abscess ( nanH, P<0.001; nanP, P=0.007; fimA, P<0.001; fimC, P=0.037; fimE, P<0.009; fimG, P<0.001; and cbpA, P=0.872). Our findings suggest differences in the pathogenic potential of T. pyogenes at individual sites may help to explain spatial variability of this disease. Anecdotally, the incidence of cranial abscess disease in Georgia seems to be associated with areas that were restocked with white-tailed deer from a high-fenced property in Wisconsin, US. Given the spatial distribution of this disease, we speculate that these genetic differences in T. pyogenes may have arisen from white-tailed deer restocking efforts, and our observations may be a legacy of an introduced disease manifesting itself generations later.

Atypical imaging findings in a case of intracranial tuberculoma

Tuberculosis is a major public health problem in developing nations like India. Tuberculosis of the central nervous system is not uncommon. Meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas can present as solitary lesion or multiple lesions. Many atypical radiological findings of tuberculomas are known. They may be indistinguishable from cranial abscess or primary brain tumour. In India, tuberculoma should be considered as a differential in patients with intracranial mass lesions. We present a case of intracranial tuberculoma mimicking a high grade gliomas on magnetic resonance imaging and clinical presentation. A 58-year-old male presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a in right gangliocapsular region peripheral ring-enhancing lesions with central necrosis and one of the lesion showing thick wall enhancement and highly raised choline/creatinine rat. There was a strong suspicion of glial tumour. On CSF studies of the patient, 100% lymphocytes were noted and no malignant cells were seen. The patient was treated with antituberculous chemotherapy.

Complications of Sinusitis, Management with Limited Resources-: A Report of Two Cases with a Review of the Literature

Unusual clinical presentations of intra cranial suppurative complication of sinusitis make it difficult to be to be diagnosed and make it a challenging task. Even in present time this pathology is known to produce significant morbidity and mortality. A short review of the literature on ICS has been done with our experience of two cases who had varying clinical presentations and in spite of their management with limited available resources, both the cases recovered fully with limited morbidity. The first case, a 12 years old boy had no clinical evidence of sinusitis but had high fever, signs of increased intra cranial pressure, orbital cellulites and abscesses on left upper eye lid and on same side of forehead. The CT scan revealed Fronto- Maxillary sinusitis, periorbital cellulites, lid and forehead abscesses along with oedema in brain for which an external Fronto-Ethmoido-Maxillary antrostomy [Lynch-Howarth operation] was done along with drainage of extra cranial abscesses in the eyelid and forehead. The second case, a 21 years old female, known to have nasal allergies had a high fever, right eye congested and proptosed and had signs of increased ICP. The CT and MRI revealed that she had a subdural empyma, Frontal sinusitis and a periorbital Cellulites. The subdural empyma was drained by a neuro- surgeon and the sinus abscesses were drained [Lynch Howarth operation] by an Otolaryngologist, at the same time. Both the patients recovered in 4 to 6 week. In conclusion, the diagnosis of ICS requires a high index of suspicion and early radiographic imaging [CT/MRI] of the head and paranasal sinuses. An aggressive medical therapy is indicated and it may require drainage of the sinus abscess and the intra cranial abscess, at the same time.

EPIZOOTIOLOGY OF CRANIAL ABSCESS DISEASE IN WHITE-TAILED DEER (ODOCOILEUS VIRGINIANUS) OF GEORGIA, USA.

Intracranial abscess disease is a cause of natural mortality for mature male white-tailed deer (Odocoileus virginianus). Most cases of abscesses are associated with bacterial infection by Trueperella (Arcanobacterium) pyogenes, but a complete understanding of the epidemiology of this disease is lacking. We quantified the effects of individual characteristics, site-specific herd demographics, land cover, and soil variables in estimating the probability of this disease. We examined 7,545 white-tailed deer from 60 sites throughout Georgia US for signs of cranial abscesses, the predecessor of intracranial abscesses, and recorded the presence or absence of cranial abscesses for each individual examined. We detected no cranial abscesses in 2,562 female deer but 91 abscesses in 4,983 male deer examined (1.8%). A generalized linear mixed model, treating site as a random effect, was used to examine several potential explanatory risk factors including site-level landscape and soil characteristics (soil and forest type), demographic factors (deer density and male to female ratio), and individual host factors (deer sex and age). Model results indicated that the probability of a male having a cranial abscess increased with age and that adult sex ratio (male:female) was positively associated with this disease. Site-specific variables for land cover and soil types were not strongly associated with observations of the disease at the scale measured and a large amount of among-site variability remained. Given the demonstrated effect of age, gender, and local sex ratios but the remaining unexplained spatial variability, additional investigation into spatiotemporal variation of the presumed bacterial causative agent of cranial abscesses appears warranted.

Epethelial presence of Trueperella pyogenes predicts site-level presence of cranial abscess disease in white-tailed deer (Odocoileus virginianus).

Cranial/intracranial abscess disease is an emerging source of significant mortality for male white-tailed deer (Odocoileus virginianus). Most cases of cranial/intracranial abscess disease are associated with infection by the opportunistic pathogen Trueperella pyogenes although the relationship between the prevalence of the bacteria and occurrence of disease is speculative. We examined 5,612 hunter-harvested deer from 29 sites across all physiographic provinces in Georgia for evidence of cranial abscess disease and sampled the forehead, lingual, and nasal surfaces from 692 deer. We used polymerase chain reaction (PCR) to determine presence of T. pyogenes from these samples. We found T. pyogenes prevalence at a site was a predictor for the occurrence of cranial abscess disease. Prevalence of T. pyogenes did not differ between samples from the nose or tongue although prevalence along the forehead was greater for males than females (p = 0.04), particularly at sites with high occurrence of this disease. Socio-sexual behaviors, bacterial prevalence, or physiological characteristics may predispose male deer to intracranial/cranial abscess disease. Determination of factors that affect T. pyogenes prevalence among sites may help explain the occurrence of this disease among populations.

Isolation and genotypic characterization of Trueperella (Arcanobacterium) pyogenes recovered from active cranial abscess infections of male white-tailed deer (Odocoileus virginianus).

Trueperella (Arcanobacterium) pyogenes is a causative agent of suppurative infections in domestic and wild animals. In some populations of captive or free-ranging white-tailed deer (Odocoileus virginianus), cranial abscess disease is an important source of mortality in adult males. Although the pathogenesis of this disease is poorly understood, T. pyogenes has been isolated from active infections with other opportunistic bacteria. In this study, bacteria associated with cranial abscess infections were identified, the prevalence of T. pyogenes associated with these infections was determined, and the presence of known virulence determinants in T. pyogenes isolates was ascertained. Using routine biochemical techniques seven bacterial species were identified from 65 samples taken from active cranial abscess infections of 65 male white-tailed deer. Trueperellapyogenes was recovered from 46 samples; in 32 samples it was the only bacterium species detected. Staphylococcus aureus was detected in 26 samples. From these samples, the presence of known and putative virulence genes of T. pyogenes--plo, nanH, nanP, cbpA, fimA, fimC, fimE, and fimG--was examined by conventional polymerase chain reaction. All T. pyogenes isolates were positive for the pyolysin genes plo, nanP, and fimA. Furthermore, nanH, fimA, fimC, and fimE were detected in over 70% of isolates. Of the isolates tested, 48% had genotypes containing all virulence genes except cbpA. The suggestive virulence potential of all isolates, coupled with the large number of pure cultures obtained, implies that T. pyogenes is a causative agent of cranial abscess disease.

Cystic Lesion Growing Like Abscess Developing after Chronic Subdural Hematoma Drainage

Chronic subdural hematoma and cranial abscess are two phenomena that are easy to differentiate in daily neurosurgical practice. Although the neurological symptoms may be the same in both, today’s imaging techniques and laboratory facilities are helpful for a definitive diagnosis. In this study, a patient who was operated on for a subdural hematoma came to the emergency room after 1 month with distinct hemiparesis appearing in the right arm and speech difficulties. Hospitalized due to the appearance of an abscess, which had a pachys capsule, keeping the contrast in the left parietal in the cranial CT and MR, the patient was operated on, and the mass was excised, along with the capsule. The lesion of the patient, which showed no reproduction in the culture, was diagnosed as a growing hemorrhagic cystic lesion, covered by a thick capsule. The literature showed no such growing cystic lesion causing a shift like an abscess after chronic subdural hematoma operation. We believe that it would be appropriate to consider a differential diagnosis, besides diagnoses, such as abscess or subdural empyema. Do we evaluate cystic lesion like abscess such as inflammatory response.

Cerebral melioidosis for the first time in the western hemisphere

This report is the first published case of cerebral melioidosis in the western hemisphere. In this paper the authors review the literature on neurological melioidosis and its presentation and treatment in endemic areas, describe the clinical course of this unique case of a presentation of the disease with cranial abscess in the US, review the pathological and radiological findings associated with this seminal case, and put forth recommendations for recognizing and treating possible future instances of the disease within the western hemisphere.

Cholesteatoma ? A Potential Consequence of Chronic Middle Ear Inflammation

The article provides an overview on the current state-of-science of middle ear cholesteatoma, a non-neoplastic, keratinizing lesion that is characterized by the proliferation of epithelium with aberrant micro-architecture. Pathogenetic mechanisms including morphological, immunological, epidemiological and microbiological aspects of the disease are summarized. The importance of penicillinase-expressing anaerobic bacteria and biofilm formation for maintaining the chronic middle ear inflammation is stressed. Nevertheless, the role of the isolated pathogens in the primarily non-sterile compartiment of the middle ear cavity is so far not completely understood and data on the isolated species are contradictious. Heredity was demonstated for some variants of the disease. Therefore, further studies on the etiological role of microbial agents and potential benefits of resistance-adapted antimicrobial therapy seem advisable. Local and systemic complications of the potentially life-threatening disease like conductive and sensorineural hearing loss and cranial abscesses are reported. The prognosis is limited due to frequent recurrence in spite of surgical therapy. Further research is necessary for a better understanding of the pathogenetic mechanisms and to expand the sectrum of therapeutic options.

Cerebral tuberculoma mimicking high grade glial tumor

Tuberculosis has been an important public health problem in both developing and develop nations. Tuberculosis of the central nervous system is rare. Tuberculosis meningitis and tuberculoma are the two most important manifestations of tuberculosis of the CNS. Intracranial tuberculomas may be solitary or multiple. Solitary tuberculomas may be indistinguishable from cranial abscess or primary brain tumor. It is necessary to rule out tuberculoma in patients with intracranial mass lesions. We present a case of tuberculoma mimicking a high grade glial tumor on magnetic resonance imaging and clinical presentation. A 30-year-old woman presented with one-month history of epilepsy. Cranial magnetic resonance imaging showed a left occipital peripheral ring-enhanced lesion with central necrosis. There was a strong suspicion of glial tumor. The lesion was totally excised with left occipital craniotomy. Histological examination of mass revealed a tuberculoma. The patient was treated with antituberculous chemotherapy.

Epidural abscesses in Africa

Paradural suppurations (epidural and subdural empyema) are serious infections of the CNS that frequently have a grave prognosis. The review by Pradilla and co-authors in the March issue of The Lancet Neurology is a good overview of epidural abscesses that succinctly discusses management strategies for patients with cranial or spinal epidural abscesses. I agree with Pradilla and co-authors that restricted access to health facilities is an important contributor to the poor outcome of patients with epidural abscesses in Africa. Medical practitioners need to educate the population actively about the various risk factors, particularly adequate treatment of infections in the paranasal sinuses, which are a leading cause of intracranial suppuration but are often not regarded as a serious risk factor by the general population. Sickle cell disease is an important but commonly forgotten risk factor. Diagnosis of sickle cell disease can be delayed as sickle-cell-related back pain might be misconstrued as an indicator of a vaso-occlusive crisis. A high index of suspicion is therefore needed when a patient presents with back pain. Tuberculosis is another important cause of epidural abscesses, not only in Eurasia, as pointed out by Pradilla and co-authors, but in all developing economies, including subSaharan Africa, where overcrowding, malnutrition, and HIV/AIDS are still important public-health concerns. Pott’s disease is sometimes accompanied by spinal epidural abscesses, which occur usually in low regions of the spine owing to the downward gravitational tracking of the pus. Pott’s puff y tumour might coexist with cranial epidural abscess and implies the presence of an abscess or other intracranial suppuration, such as subdural empyema. Cranial epidural abscesses were found in fi ve of seven children with Pott’s puff y tumour who presented at an Ohio (USA) hospital, despite the children being given antibiotics. Epidural abscesses have also been reported after central nerve block and epidural anaesthesia or analgesia. The prognosis in these conditions is similar to that for noniatrogenic epidural abscesses.

Meningococcal meningitis with myelopathy: case report and review of literature

Abstract Neisseria meningitis is a common etiological agent in bacterial meningitis in humans. Common complications associated with meningococcal meningitis include cranial nerve palsies, hydrocephalus, seizures, stroke, cerebritis or brain abscesses. Spinal cord dysfunction is a very rare complication of meningococcal meningitis and its occurrence is limited to case reports only. We report such a case along with a review of available literature and underlying pathogenetic mechanisms. Case report: Our patient diagnosed as a case of meningococcal meningitis developed multiple cranial nerve palsies followed by flaccid paraplegia with bowel bladder involvement during the recovery phase of the disease. Spine MRI showed mild cord edema and diffuse patchy areas of altered intramedullary signal intensity in dorsal cord suggestive of myelitis. The patient was treated with antibiotics and intravenous methyl-prednisolone along with supportive physiotherapy. His neurological deficits showed marked improvement on subsequent follow up.