Pyogenic Brain Abscess Research Articles

A Study of the Etiology, Clinical Profile, and Diagnosis of Various Types of Central Nervous System Infections in a Tertiary Care Center.

Introduction Infections affecting the central nervous system (CNS) can stem from various sources, including bacteria, viruses, and fungi, manifesting as conditions like meningitis, encephalitis, meningoencephalitis, and brain abscesses. Despite significant advancements in diagnosis and treatment, these infections continue to pose substantial risks to life. Several factors contribute to the causes of CNS infections. Demographic and geographic elements, the health status of individuals, their immune system's strength, the availability of diagnostic tools, and local prevention initiatives, all play pivotal roles. Consequently, the necessity of comprehensive local epidemiological data becomes undeniable as it guides the need for further studies and research. Understanding these factors is crucial for enhancing preventive measures and optimizing treatment strategies in tackling CNS infections. Aims and objectives This research aims to study the etiology and clinical features of different CNS infections among hospitalized patients and to diagnose cases of CNS infections based on laboratory and radiological investigations. Material and methods One hundred adults, seeking treatment for neurological impairments at a specialized tertiary care center in Gujarat, India, volunteered for this cross-sectional observational research. The study investigated the etiology, clinical profiles, and diagnoses of different CNS infections. It delved into the prevalence of these infections across age and sex categorieswhile also observing mortality rates. Results In our research, we observed that bacterial causes were the most prevalent among CNS infections. Tubercular meningitis accounted for 36%, tuberculoma 14%, and pyogenic bacterial infections 23%. Following this, fungal infections emerged as the second most frequent, with mucormycosis at 9% and cryptococcus at 1%. Other less common CNS infections included viral encephalitis (4%), neurocysticercosis (3%), and brain abscess (1%). Middle-aged individuals between 41 and 60 years were most commonly affected (43%), followed by those aged 21-40 years (31%). Males accounted for a higher percentage of cases at 58%. Clinical symptoms revealed fever as the predominant feature (80%), with headaches following closely at 67%. Acute presentations were prevalent, representing 83% of cases, while neck stiffness was noted in 62% of patients. Most patients exhibited normal hemoglobin levels (96%) and a majority had a normal total leukocyte count (79%). Notably, 31% of the studied patients were identified as People Living With HIV (PLHIV). Out of 100 patients, 79 survived with appropriate treatment, resulting in a mortalityof 21%. Conclusion The study identified various CNS infections, including bacterial (acute pyogenic meningitis, tubercular meningitis, tuberculoma, brain abscesses, and neurosyphilis), viral (viral meningitis and encephalitis), fungal (cryptococcal meningitis and CNS mucormycosis), and parasitic infections (neurocysticercosis and CNS toxoplasmosis). Tuberculous meningitis emerged as the most prevalent, followed by pyogenic meningitis. Clinical symptoms predominantly featured fever, headache, and altered sensorium, with less common occurrences of seizures, vomiting, weakness, and speech disturbances. Elevated CSFproteins and total leukocyte count were common findings in CSF analysiswhile consistent radiological observations included hypodensities in brain tissue and leptomeningeal enhancement.

Radiological Progression of Pyogenic Brain Abscess with Antibiotics uses Compared to Surgical Intervention

Background: Brain abscess is a worldwide health problem with a high morbidity and mortality rate. It begins as a localized area of cerebritis and develops into an encapsulated will-formed abscess. The Pyogenic brain abscess formation starts when bacteria enter cerebral tissues as with trauma, or contiguous spread from a suppurative focus or through hematogenous dissemination from a distant infection. Methods: The study analyses the effect of antibiotics versus the surgical intervention in the curative treatment of pyogenic brain abscess. It is a retrospective analysis study conducted on a series of 25 patients having various stages of pyogenic brain abscess (BA) diagnosed between January 2018 and January 2023 in our institution. All the patients conducted a standard data collection including clinical assessment, radiological and laboratory investigations, medical treatment (with triple intravenous antibiotics), and surgical abscess aspiration. The surgical and medical treatments were compared depending on the radiological and the clinical improvement. Results: Clinical improvement was temporary for all patients with continuous medical treatment for a short time, without radiological improvement. While after surgical aspiration all patients had dramatic radiological, clinical, and laboratory improvement. Conclusion: The gold standard treatment of brain abscess is surgical intervention. Medical treatment could reduce the clinical effects of brain abscess, but it is not considered as a definitive cure.

1318. Clinical Characteristics of Patients with Patent Foramen Ovale and Pyogenic Brain Abscess

Abstract Background Patent foramen ovale (PFO) can be identified in about 20-25% of the adult population and may result in variable degrees of left-to-right and right-to-left intracardiac shunting. The association between PFO and pyogenic brain abscess remains poorly understood. The current study aimed to compare the clinical characteristics and outcomes of pyogenic brain abscess in patients with and without PFO. Methods All adults with pyogenic brain abscess seen at Mayo Clinic from 1/1/2009-12/31/2021 who underwent either transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) with agitated saline shunt (bubble) study were included. Results A total of 222 patients developed pyogenic brain abscess during the study period; 148 (66.7%) patients were excluded due to unknown PFO status. Among 74 remaining patients, PFO was detected in 30 (40.5%) patients; 25 by TEE and 5 by TTE with bubble study (Figure 1). The prevalence of cryptogenic brain abscess (unable to identify the source of abscess) was significantly higher in patients with PFO as compared to those without PFO (53.3% versus 18.2%, p=0.002). Patients with PFO had a larger abscess size (25 mm [IQR 15.8-37.5] versus 15.5 mm [IQR 10.0-28.0], p=0.038). However, multiple abscesses were more common in the group without PFO (43.2% versus 20.0%, p=0.038). Additionally, patients with PFO had less documented bloodstream infection. There were no differences between other clinical characteristics and one-year, all-cause mortality between two groups. Conclusion These findings provide critical insights into the likely association between PFO and cryptogenic brain abscess; additional investigation is warranted. Disclosures Larry M. Baddour, MD, Boston Scientific: Advisor/Consultant|Roivant Sciences: Advisor/Consultant

Single Cerebral Metastasis Mimicking Pyogenic Abscess in a Patient with Lung Adenocarcinoma.

HomeRadiology: Imaging CancerVol. 5, No. 3 Images in CancerFree AccessSingle Cerebral Metastasis Mimicking Pyogenic Abscess in a Patient with Lung AdenocarcinomaVíctor Pérez-Riverola , Olalla Vázquez Muiños, Mario Prenafeta Moreno, Roser Monmany Badia, Khalid El-Hamshari Rebollo, Esther Granell MorenoVíctor Pérez-Riverola , Olalla Vázquez Muiños, Mario Prenafeta Moreno, Roser Monmany Badia, Khalid El-Hamshari Rebollo, Esther Granell MorenoAuthor AffiliationsFrom the Department of Neuroradiology, UDIAT-CD, Hospital Universitari Parc Taulí, Parc del Taulí 1, 08208 Sabadell, Spain.Address correspondence to V.P.R. (email: [email protected]).Víctor Pérez-Riverola Olalla Vázquez MuiñosMario Prenafeta MorenoRoser Monmany BadiaKhalid El-Hamshari RebolloEsther Granell MorenoPublished Online:Apr 7 2023https://doi.org/10.1148/rycan.230004MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In As clinical signs of infection are often absent in patients with pyogenic abscesses, differential diagnosis with cerebral metastases is based on MRI findings.However, both entities often manifest as ring-enhancing lesions. Pyogenic brain abscesses usually show restricted diffusion in the lesion core and the dual-rim sign at susceptibility-weighted imaging. The dual-rim sign consists of two concentric rims bordering the lesion: a complete, smooth outer hypointense rim representing the fibrocollagenous capsular wall and an inner hyperintense rim representing a zone of granulation tissue (1). At perfusion imaging, the capsule of a cerebral abscess has a lower relative cerebral blood volume than the necrotic or cystic peripheral wall of a tumor due to microvessel angiogenesis by the tumor (2).Some cerebral metastases also show restricted diffusion, which does not correlate with the histologic type of the primary cancer (3). Proposed mechanisms for restricted diffusion in metastases include intracellular edema in viable tumor cells during transition to complete liquefactive necrosis (4) and a highly viscous mucin concentration (5).Key findings that help distinguish these atypical metastases from pyogenic abscess include high peripheral wall relative cerebral blood volume and absence of the dual-rim sign (Figure).Brain MR images in a 37-year-old male patient, a heavy tobacco and cannabis smoker, after a first seizure. (A) Contrast-enhanced T1-weighted MR image shows a smooth, ring-enhancing nodular right frontal lobe lesion surrounded by abundant vasogenic edema. (B, C) On diffusion-weighted images, the central core shows restricted diffusion. (D) On susceptibility-weighted image, a hypointense smooth ring completely surrounds the lesion, simulating a capsule. (E) The relative cerebral blood volume of the lesion’s peripheral wall (arrows) is high (mean relative cerebral blood volume ratio: 7.61 ± 2.70 [SD]). Chest CT findings (not shown) detected a cavitary pulmonary mass. Tests for tuberculosis and bronchoalveolar lavage fluid analysis were negative. Chest CT findings were initially misinterpreted as an infectious process. Follow-up brain MRI 8 weeks after starting antibiotics showed enlargement of the frontal lobe lesion, new ring-enhancing cerebral and cerebellar lesions, and signs of leptomeningeal carcinomatosis in the posterior fossa. The patient was diagnosed with lung adenocarcinoma following lung lesion biopsy.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: V.P.R. No relevant relationships. O.V.M. No relevant relationships. M.P.M. No relevant relationships. R.M.B. No relevant relationships. K.E.H.R. No relevant relationships. E.G.M. No relevant relationships.Keywords: MRI, MR-Diffusion-weighted Imaging, MR-Perfusion, Metastasis, Neuro-oncology, Lung Adenocarcinoma, Pyogenic AbscessAuthors declared no funding for this work.

Impact of a visiting consultant neurosurgeon: The Nigerian experience

ObjectiveTo study the impact of a visiting consultant neurosurgeon on the management and outcome of neurosurgical patients in a hospital with no resident neurosurgeon. MethodsThis is a 5-year retrospective study of neurosurgical conditions and their management outcomes by a visiting consultant neurosurgeon in a Nigerian Tertiary institution from January 2016 to December 2020. ResultsThousand two hundred and four (1,204) patients were reviewed. Patients' ages were between 1 h and to 86-year-olds, with a mean of 23 years and a mode of 32 ± 4 years. Children were 423 (35.1%), with 781(64.9%) adults. Males were 862 (71.6%), and Females were 342 (28.4%), with a Male to Female ratio of 5:2. Congenital problems were 170 (14.1% of 1204): meningocoeles (38, 22.4%), myelomeningocoeles (61, 35.9%), encephalocoeles (24, 14.1%), anencephaly (6, 3.5%), and hydrocephalus (41, 24.1%). Acquired conditions were 1034 (85.9% of 1204): Head injuries (486, 47%), spinal cord injuries (51, 5%), Pyogenic brain Abscess (3, 0.3%), Pott's disease (2, 0.2%), Hydrocephalus (63, 6.1%), brain tumour (5, 0.5%), degenerative spine (421, 40.7%), vascular (3, 0.3%). Surgery was indicated in 348(28.9%) patients. Two hundred and twenty-six (18.8% of 1204) had surgeries, while 978 (81.2% of 1204) had no surgeries. Referred to other facilities were 122 (10.1%). Overall, surgical intervention was 64.9% (226 of 348), with mortality of 13.5% (18 patients) among those who had surgical interventions. ConclusionsIn countries with very few medical specialists, particularly neurosurgeons, such a regular visit can impact the care of neurosurgical patients in their environment.

Differentiating Pyogenic Brain Abscesses and Tuberculous using Magnetization Transfer MR Imaging and in Vivo Proton MR Spectroscopy

Objective: To find whether in vivo proton MR spectroscopy and magnetization transfer (MT) MR imaging can be used to differentiate between tuberculous brain abscess and pyogenic brain abscess. Study Design: Retrospective Place and duration: Radiology Department of Ibn_e_Sina Hospital Multan from January 2021 to January 2022. Methodology: The study included 15 subjects with brain abscesses who underwent in vivo MR spectroscopy, MT MR imaging and conventional MR imaging. Those with other systemic diseases were excluded. These techniques were also performed on 10 sex and age-matched control subjects for comparing MT ratios in normal and diseased parenchymal locations. 13 tuberculous abscesses were found in 4 patients, and 20 pyogenic abscesses were found in 11 patients. MT MR imaging and in vivo MR spectroscopy were used to evaluate suspected brain abscesses. Results: The mean MT ratio of the pyogenic brain abscesses was 25.55±1.60.MR spectroscopy showed that in pyogenic abscesses level of amino acids (valine, isoleucine, leucine) was 0.8 ppm and lipid and lactate was 1.2 ppm. Additionally, acetate, 1.91 ppm; glycine, 3.55 ppm; succinate,2.40 ppm and alanine, 1.47 pm were also seen. Four patients had 13 tuberculous abscesses. The mean MT ratio obtained from tuberculous abscesses was 19.87±1.54, which was significantly lower compared to the cortical grey matter, deep grey matter, white matter and pyogenic abscess (p<.001). Conclusion: MT ratios in tuberculous brain abscesses were lower than in pyogenic abscesses. In vivo, MR spectroscopy in pyogenic abscesses did not show amino acids. Tuberculous brain abscess can be differentiated from the pyogenic abscess by using both in vivo MR spectroscopy and MT MR imaging. Keywords: Pyogenic brain abscess, tuberculous brain abscess, MR spectroscopy

Predictors of Treatment Failure in Patients With Pyogenic Brain Abscess

BackgroundPyogenic brain abscess poses a significant management challenge to clinicians, hence early diagnosis and interventions are critical. Our objective was to assess predictors of failure of therapy among patients with pyogenic brain abscesses according to surgical versus medical treatment.MethodsRetrospectively reviewed adults with pyogenic brain abscesses at our institution between 2009 and 2020. Treatment was classified as early surgical intervention and no early surgical treatment (medical therapy). Propensity score (PS) adjustment and multivariable regression were used to assess risk of treatment failure from surgical intervention and baseline covariates.ResultsA total of 224 patients had pyogenic brain abscess, of whom 106 (47.3%) had early surgical treatment and 118 (52.7%) had medical treatment only. Significant predictors of surgical (vs. medical) treatment included essential hypertension (odds ratio [OR] 95% confidence interval [95% CI] = 2.06 [1.01–4.18]), abscesses number (single vs. multiple, OR [95% CI] =4.81 [1.64–14.08]), midline shift (OR [95% CI] = 3.09 [1.22–7.82]). At 6 months, treatment failure cumulative incidence was 27.1% in the medical group (n = 31) and 21.3% in early surgical group (n = 22). PS-adjusted analysis showed beneficial effect of early surgical treatment (hazard ratio [HR] [95% CI] = 0.55 [0.31–0.98]). Multivariable regression showed similar but statistically nonsignificant estimate of surgical benefit (HR [95% CI] =0.59 [0.34–1.01]; P = 0.056), and significant associations of Charlson Comorbidity Index (CCI) (P = 0.019) and pre-existing central nervous system hardware (P = 0.034) with increased risk of treatment failure.ConclusionsHigher CCI and pre-existing CNS hardware were significant risk factors associated with treatment failure. In propensity-adjusted analysis, early surgery was associated with a 45% reduction in risk of 6-month treatment failure.

Conservative management of multiple pyogenic brain abscess from a rare hematogenous spread

This is a rare case of hematogenous spread of brain abscess in a young immunocompetent adult, who presented with an acute onset of symptoms of 1-week duration of headache and sudden onset of seizure. With the patient’s refusal for neurosurgical intervention, the choice for conservative management with aggressive antibiotics and close monitoring proved to be a viable alternative treatment.

A Case Report on Sphenoidal Sinusitis with Brain Abscess in a 16 Year Old

A pyogenic infection-induced brain abscess is rare, and usually affects immunocompromised people. Brain imaging and bacterial culture from the infection site are used to diagnose a brain abscess. An effective treatment method is surgical resection combined with antibiotic treatment with bacteria-sensitive antibiotics for a sufficient period of time.
 Presentation of the Case: A 16-year-old boy was confirmed to have Sphenoidal Sinusitis. The patient had been diagnosed with dengue fever three weeks ago and corona infection four months ago. And finally, he was diagnosed with Sphenoidal Sinusitis which manifested as severe headache, vomiting, and fever. He underwent bilateral Functional Endoscopy Sinus Surgery (FESS), sphenoidotomy and also temporal craniotomy and evacuation of abscess.
 Conclusion: The treatment of a brain abscess requires early diagnosis, appropriate surgical treatment, and adequate duration of therapy with effective antibiotics.

267. Therapeutic Management of Bacterial Brain Abscess: An Overview of Diagnosis and Outcomes

BackgroundWe describe and compare the clinical, diagnostic evaluation and outcomes of patients who underwent therapeutic management for pyogenic brain abscess.MethodsWe retrospectively reviewed adults who presented with pyogenic brain abscess from January 1, 2009 through June 30, 2020.Results231 patients were identified during the study period. Sixty-one (26.4%) patients received antibiotic therapy alone, and 170 (73.6%) had a combination of antibiotic therapy and surgical intervention. The median age for the medical and combined therapy group was 59 years and 58 years, respectively. Patients who received medical treatment had a higher prevalence of infective endocarditis than those who received combined therapy (6.6% vs. 0.6%; P=0.005). The medical therapy group was more likely to have brain MRI and cranial CT than the patients with combined therapy (75.4% vs. 63.5%; P=0.041). Midline shift (11.5% vs. 31.2%; P=0.002), a single (21% vs. 83%; P=0.001) and greater size (1.4 cm vs. 2.5 cm; P=0.007) brain abscess was significant when comparing medical vs. surgically managed abscess. Stereotactic surgical technique was the preferred diagnostic approach for the medical group (65.6% vs. 46.5%; P=0.010), and excision/craniotomy for the combined group (31.1% vs. 53.5%; P=0.002). Streptococcus viridans group was the predominant organism (32.8% and 25.9%; P=0.30). Compared to those who received combined therapy, patients with medical therapy alone were most likely to receive cephalosporin (72.1% vs. 41.2%; P=< 0.0001), vancomycin (23% vs. 12.4%; P=0.047) and metronidazole (27.9% vs. 14.7%; P=0.022). In both groups, median duration of antimicrobial therapy was 42 days (P=0.12). Patients with medical therapy alone had a higher mortality rate (18% vs. 7.1%; p=0.014) but less neurologic sequelae (21.3% vs. 30.6%; P=0.16) compared with combined therapy. Medical Management. Organism isolated in the medical management group Combined Management. Organism isolated in the combined management group Demographic and Clinical Characteristics of Patients with Brain Abscess who Underwent Therapeutic Management ConclusionMost patients with pyogenic brain abscess had no identified risk factors, and brain MRI and cranial CT were the diagnostic imaging modalities of choice. Compared to those who received medical therapy alone, patients with combined treatment had a single and greater size fluid collection with the presence of midline shift. A prompt combined surgical and medical approach with prolonged antimicrobial therapy can cure the infection.Outcomes of Patients with Bacterial Brain Abscess Radiologic and Surgical Diagnosis of Patient with Brain Abscess who Underwent Therapeutic Management Disclosures John C. O’Horo, Sr., MD, MPH, Bates College and Elsevier Inc (Consultant) M. Rizwan Sohail, MD, Medtronic Inc., Philips, and Aziyo Biologics, Inc (Consultant) M. Rizwan Sohail, MD, Aziyo Biologics (Individual(s) Involved: Self): Consultant; Philips (Individual(s) Involved: Self): Consultant

Cysticercal brain abscess: a distinct entity mimicking pyogenic brain abscess in the colloidal vesicular stage

Cysticercal brain abscess is a rare entity with the clinical presentation and radiological findings closely mimicking a pyogenic abscess. We report three cases of cysticercal abscess presenting as solitary lesion in the brain with radiological appearance like an abscess. All the patients underwent excision of the lesion with histopathological diagnosis of cysticercal brain abscess with evidence of cysticerci in the colloidal vesicular stage. The clinical outcome was satisfactory after surgical excision. Cysticercal abscess, though rare, should be considered as a differential diagnosis of a solitary rim-enhancing lesion, mainly if the patients belong to the endemic zone of neurocysticercosis. Surgical excision with or without a short course of the anti-parasitic agent is the treatment of choice for the intracranial mass lesion with evidence of mass effect For the small lesion of cysticercal brain abscess or early stage of abscess, anti-parasitic medication and steroids can be considered.

Brain abscess complicating a diabetic man with Evans syndrome: a case report

Brain abscess is a relatively rare but potentially life threatening condition. The classic clinical triad of fever, headache and focal neurological sign may not be present in an immuno-compromised patient. The diagnostic delay may result in fatal outcome. A 52-year-old diabetic gentleman with history of chronic immunosuppressive therapy due to Evans syndrome presented with headache, generalized tonic- clonic seizure and right upper limb monoparesis. Clinical ground and neuroimaging was suggestive of pyogenic brain abscess. Patient was treated with antibiotic therapy for prolong period and there was complete clinical and radiological recovery.&#x0D; Birdem Med J 2021; 11(2): 137-141

Cerebral aspergillose

The diagnosis of intracerebral fungal abscesses may be difficult due to the paucity of laboratory tests and similar radiological appearance to other lesions. We present an immunocompromised woman in her forties who was admitted with a diagnosis of bacterial meningitis. MRI examination showed findings suggestive of fungal abscesses, and a subsequent lumbar puncture showed PCR positive for non-fumigatus Aspergillus. The patient received antifungal treatment and had satisfactory clinical, biochemical and radiological response. Consecutive MRI examinations over the following weeks showed gradual decrease of abscesses, with almost complete resolution within 12 weeks. Adequate management of brain abscesses requires correct identification of the causative agent, so that proper treatment can be initiated as soon as possible. MRI plays an important role in distinguishing between pyogenic and fungal brain abscesses. Headaches or focal neurological deficits in immunocompromised patients should cause CNS fungal infection to be considered.

Serratia marcescens Healthcare-Associated Ventriculitis and Cerebral Abscess in a Neonate with Chiari II Malformation: A Case Report and Systematic Review

Serratia marcescens is a recognized nosocomial opportunistic pathogen but rarely caused central nervous system infection especially in the neonates. Outbreaks have been documented in the neonatal intensive care units (NICU) and a higher incidence among those with surgical procedures. This review aims to describe a neonate with nonleaking lumbosacral myelomeningocele presenting with multiple pyogenic brain abscesses caused by S. marcescens admitted in a NICU. This review also presents a concise literature review discussing the potential risk factor involved, diagnostic measures and therapeutic possibilities. We present a neonate with Chiari II malformation admitted in the NICU developing S. marcescens ventriculitis after a lumbosacral myelomeningocele repair. With an empiric treatment of meropenem for one week, repeat ventricular cerebrospinal fluid analysis worsened and developed cerebral abscess as detected using cranial ultrasound. Ciprofloxacin was added and completed for six weeks with improved neurologic status. On a 6-month follow-up, sensorineural hearing loss, focal epilepsy and developmental delay were documented. A systematic review showed that prematurity and NICU outbreaks were among the most common risk factors for the central nervous system involvement of S. marcescens. Meropenem remains to be the antibiotic of choice adjunct with timely neurosurgical intervention. Brain abscess showed the worst prognosis among the neurologic sequelae.

ROLE OF IMAGING IN DIAGNOSIS OF INTRACRANIAL INFECTIONS- LITERATURE REVIEW

Neuroimaging performs an essential position in the analysis and diagnostic choice making in infectious illnesses of the world. The overview summarizes imaging findings and latest advances in the diagnosis of pyogenic brain abscess, ventriculitis, viral diseases which includes distinguished and emerging viruses, and opportunistic infections. For each circumstance, the ensuing therapeutic steps are presented. In instances of typical meningitis, cranial computed tomography (CT) seems to be enough for clinical control to exclude acute cerebral edema, hydrocephalus, and pathology involving the base of the skull. Magnetic resonance imaging (MRI) is advanced in depicting complications like subdural and epidural empyema and vasculitic complications considerably on FLAIR (fluid-attenuated inversion healing)-weighted pics. The more recent technique of diffusion-weighted imaging (DWI) suggests early parenchymal headaches of meningitis in advance and with greater readability and is of assist in differentiation of pyogenic abscess (PA) from ring enhancing lesions of other etiology. Proton magnetic resonance spectroscopy (PMRS) seems to produce unique top patterns in instances of abscess. The presence of lactate cytosolic amino acids and absence of choline appears to signify PA. Additionally in instances of suspected opportunistic infection because of toxoplasma DWI can be of very helpful inside the differentiation from lymphoma, showing no limit of water diffusion. In patients with herpes simplex and extra exceptional viruses like West Nile and Murray Valley virus, DWI lets in advance lesion detection and better therapeutic intervention with virustatic tablets.

Case report: Oral antibiotics as conservative management of multiple pyogenic brain abscesses from a rare hematogenous spread

This is a rare case of hematogenous spread of brain abscess in a young immunocompetent adult, who presented with an acute onset of symptoms of one-week duration of headache and sudden onset of seizure. With the patient's refusal for neurosurgical intervention and staying in the hospital, the choice for conservative management with aggressive oral antibiotics and close monitoring proved to be a viable alternative treatment.

Successful management of intraventricular rupture of pyogenic brain abscess (IVROBA): Systematic review and illustrative case

ObjectivesIntraventricular rupture of brain abscess (IVROBA) is one of the most dreaded complications of pyogenic brain abscess due to its high mortality rate. Because of its relative infrequency and poor outcome, the optimal management of this condition remains to be determined. Patients and MethodsWe report the case of a 5-year old female with a presumptive diagnosis of IVROBA who was discharged with good neurologic outcome after completing intravenous antibiotic treatment and undergoing insertion of an external ventricular drain (EVD) and later, a ventriculoperitoneal (VP) shunt. We also performed a systematic review of the SCOPUS and PubMed databases for case reports and series documenting patients who survived after undergoing treatment for IVROBA. ResultsA total of 24 cases of IVROBA survivors were reported in the literature, including the present case. The median age was 48.5 years (range: 5–71), with a male predilection (3:1). The most common location of the brain abscesses was temporal while the most common route of spread was hematogenous. Surgery was performed in 92% of cases, with EVD being the most common surgical procedure. Twenty nine percent of cases required a VP shunt. The duration of systemic antibiotic treatment ranged from 31 to 180 days (median: 56 days) while intraventricular antibiotics were given for 8–42 days (median: 14 days). ConclusionThe management of IVROBA in this series varied widely, with surgery playing an important role. Although IVROBA is still a devastating complication of intracranial abscess, a good neurologic outcome may still be possible with treatment.

The susceptibility ring.

The susceptibility ring.

Susceptibility-weighted imaging provides complementary value to diffusion-weighted imaging in the differentiation between pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors

PurposeThe purpose of this retrospective study was to investigate the differentiation of abscess and necrotic tumors, using susceptibility-weighted imaging (SWI) and apparent diffusion coefficients (ADC) either separated or combined. MethodsImaging was performed on 26 patients with pyogenic brain abscesses, 31 patients with rim-enhancing glioblastomas, and 21 patients with rim-enhancing metastases. The degree of intralesional susceptibility signal (ILSS) was independently assessed by three observers. Average ADC in the lesion core was calculated. After receiver operating characteristic (ROC) analysis, the area under the ROC curve was compared using three different analytical models (ILSS, ADC, and ILSS-ADC combined) to differentiate abscess from the two rim-enhancing necrotic tumors. ResultsThe ILSS-ADC combined model had greater area under the ROC curves than ILSS or ADC used alone. In this study, the ILSS-ADC combined model showed 100% diagnostic accuracy differentiating abscesses from glioblastoma. The ADC model and the ILSS-ADC combined model performed equally well in distinguishing abscesses from metastases. ConclusionIt is concluded that SWI and ADC are complementary, and the combination of SWI and ADC may improve results compared with the use of only one model. Validation by an independent cohort is the next necessary step to broaden its applicability in routine clinical settings.

Paradoxical Presentation In A Case of Deep Frontal Lobe Abscess

A pyogenic brain abscess may start initially with cerebritis and later develop a capsule and a necrotic centre thus, forming an abscess. A pyogenic abscess is not uncommon and can be due to a multitude of organisms. It may occur due to spread from a contiguous focus, haematogenous spread or head trauma etc. We report here, a case with no detectable source of infection in a case with a left to right shunt patent foramen ovale (PFO). Such a shunt is an unusual presentation as only a right to left shunt is known to bypass the pulmonary filter and lead to seeding, in the absence of a coexisting pulmonary arteriovenous malformation.