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Mohammad R, Maoldomhnaigh CÓ, Crimmins D. Clinical characteristics and outcomes of children with non-sinogenic Brain infections. Br J Neurosurg 2023:1-9. [PMID: 38149672 DOI: 10.1080/02688697.2023.2297877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Central Nervous System (CNS) suppurative infections are serious but rare conditions in the paediatric population. Data on long-term neurocognitive and quality of life outcomes in children recovering from these infections are lacking. METHODS A retrospective cohort review of children <16 years with non-sinogenic infections undergoing neurosurgery was conducted. Data for patients admitted to Children's Health Ireland at Temple St between 2008-2021 were analysed for clinical and microbiological profiles. Follow-up reviews evaluating neurological and academic sequelae and quality of life were performed. Categorical variables were analysed for unfavourable outcome with a p < 0.05 significance value. RESULTS Forty patients were included with a mean age of 4.5 years and equal gender distribution. Fever (68%) and vomiting (58%) were the most common presenting complaints. Only fourteen (35%) patients presented with the classic triad of fever, headache, and focal neurological deficit. Meningitis/Encephalitis was the most common cause of suppurative infection (40%). Predisposing factors included congenital heart disease (18%), prematurity (15%) and immunocompromised status (10%). More patients received an initial Burr hole aspiration (73%) than Craniotomy (27%). The re-operation rate was higher in the craniotomy group (45%) compared to the burr hole group (34%), but this was not statistically significant (p = 0.522). Four patients died (10%) including two intra-hospital deaths (5%). Male gender (p = 0.047) and multiple abscesses (p = 0.041) were associated with unfavourable outcome at discharge. Mobility impairment was the most affected determinant of quality of life. CONCLUSION CNS suppurative infections are associated with long-term neurocognitive sequelae in children. Multiple abscesses and male gender are associated with unfavourable GOS on discharge. Children are still left with mobility impairment (25%), personality changes (23%) and intellectual disability (18%) at an average of 5 years. Long-term follow up with multidisciplinary input is required. Further research should focus on evaluating long-term HRQoL in children.
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Affiliation(s)
- Retaj Mohammad
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
| | - Cilian Ó Maoldomhnaigh
- Department of Paediatric Infectious Diseases, Temple St Children's University Hospital, Ireland
| | - Darach Crimmins
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Teferi N, Chowdhury A, Lee S, Challa M, Weiner L, Auerbach S, Rao M, Dlouhy BJ. Pediatric brainstem abscess successfully treated with stereotactic aspiration: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23262. [PMID: 37581585 PMCID: PMC10555595 DOI: 10.3171/case23262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pediatric brainstem abscesses are rare entities that account for 1% of all brain abscesses and, when diagnosed, constitute a neurosurgical emergency. OBSERVATIONS A previously healthy 11-year-old male presented with several days of worsening headache, confusion, and ataxia. Brain magnetic resonance imaging (MRI) revealed a midbrain and pons lesion. The patient subsequently had a rapid neurological decline with loss of consciousness and brainstem function. Follow-up MRI revealed significant enlargement of the brainstem lesion with extension into the pons, midbrain, and thalamus, with greater concerns for an abscess rather than a tumor or an inflammatory process. He was taken for an emergent stereotactic aspiration of the abscess, and broad-spectrum antibiotics were initiated. He had neurological improvement, which subsequently declined 5 days later with brain MRI revealing an increase in the brainstem abscess, which required a second stereotactic aspiration. After rehabilitation, he made a significant neurological recovery. LESSONS Pediatric brainstem abscesses are rare pathologies, and a high index of suspicion is needed in patients presenting with a brainstem lesion mimicking tumor but with rapid neurological decline despite no other evidence of infection or infectious/inflammatory markers. Stereotactic aspiration is required for large lesions to target the antibiotic treatment and as an adjunct to broad-spectrum antibiotics.
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Affiliation(s)
- Nahom Teferi
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - Sarah Lee
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Lukasz Weiner
- Department of Pediatrics, Division of Infectious Disease, University of Iowa, Iowa City, Iowa; and
| | - Sarah Auerbach
- Department of Pediatrics, Division of Infectious Disease, University of Iowa, Iowa City, Iowa; and
| | - Mahil Rao
- Department of Pediatrics, Division of Critical Care Medicine, University of Iowa, Iowa City, Iowa; and
| | - Brian J. Dlouhy
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
- Iowa Neuroscience Institute, Iowa City, Iowa
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Ngo TM, Okabe A, Nguyen KB, Tong A, Chang J, Lui F. Cryptogenic Pontine Abscess Treated With Stereotactic Aspiration: A Case Report. Cureus 2023; 15:e41463. [PMID: 37546074 PMCID: PMC10404128 DOI: 10.7759/cureus.41463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Brainstem abscesses are localized collections of pus or infected material within the brainstem, which can cause inflammation, tissue damage, and compression of adjacent structures. This can lead to a variety of symptoms, including headache, fever, and focal neurological deficits, among many others. Brainstem abscesses are potentially life-threatening and considered to be rare, and pontine abscesses are even rarer. Both are often caused by the spread of infection from nearby structures like the middle ear, sinuses, and mastoid air cells, but they can also result from distant infectious sites that have spread to the bloodstream. Ambiguous clinical presentation can delay appropriate care and lead to poorer outcomes. We present a rare case of pontine abscess in a 54-year-old male with both undetermined causal origins and unclear infectious signs, namely, the lack of fever, fatigue, and chills. We will discuss the etiologies, diagnosis, and treatment of cryptogenic brainstem lesions in this case report.
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Affiliation(s)
- Taylor M Ngo
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anna Okabe
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Kailey B Nguyen
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anhtho Tong
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Jason Chang
- Neurology, Kaiser Permanente South Sacramento Medical Center, Sacramento, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
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Mohammad R, Crimmins D. Multiple Abscesses in the Frontal, Temporal and Brainstem regions in a 4.5-year-Old Girl- An Illustrative Case Report. Surg Neurol Int 2023; 14:209. [PMID: 37404497 PMCID: PMC10316199 DOI: 10.25259/sni_249_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Background Brainstem located abscesses are rare in the pediatric population. Diagnosis of brain abscess can be challenging as patients may present with nonspecific symptoms and the classical triad of headache, fever, and focal neurological deficit is not always present. Treatment can be conservative or a combination of surgical intervention with antimicrobial therapy. Case Description We present the first case of a 4.5-year-old girl with acute lymphoblastic leukemia that developed infective endocarditis (IE) and subsequently developed 3 suppurative collections (frontal, temporal, and brainstem). The patient had negative cerebrospinal, blood, and pus culture growth and subsequently underwent burr-hole drainage of the frontal and temporal abscesses with a 6-week course of intravenous antibiotic therapy with an uneventful postoperative course. At 1 year, the patient is left with minor right lower limb hemiplegia and no cognitive sequelae. Conclusion The decision to surgically intervene for brainstem abscesses is dependent on surgeon and patient factors including the presence of multiple collections, midline shift, the aim of source identification in sterile cultures, and the patient's neurological condition. Patients with hematological malignancies should be monitored closely for IE which is a risk factor for hematogenous spread of brainstem located abscesses.
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Affiliation(s)
- Retaj Mohammad
- Corresponding author: Retaj Mohammad, Department of Neurosurgery, Children’s Health Ireland at Temple St, Dublin, Ireland.
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Szewczyk AK, Mitosek-Szewczyk K. COVID-19 Co-Infection May Promote Development of Sinusitis Complication in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111636. [PMID: 36360364 PMCID: PMC9688522 DOI: 10.3390/children9111636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The olfactory dysfunction that occurs during a COVID-19 infection has sparked much debate about its similarity to sinusitis. Up to 65% of COVID-19 pediatric patients may be asymptomatic; however, when symptoms are observed, fever and cough are the most common. Nasal congestion and discharge as well as headaches can also be seen, which makes both entities, i.e., COVID-19 and sinusitis, similar to each other. METHODS In this review, we present the clinical case of a teenager with a history of acute sinusitis and COVID-19 co-infection followed by purulent meningoencephalitis. We aim to summarize available findings on the association between COVID-19, sinusitis, and possible common complications of both diseases. RESULTS Differentiating between COVID-19 and sinusitis can be confusing because presented symptoms may overlap or mimic each other. Increased risk of complications, especially in patients with bacterial sinusitis co-infected with SARS-CoV-2, should prompt physicians to monitor young patients and inform parents about disturbing symptoms and possible complications. CONCLUSIONS Acute sinusitis and COVID-19 co-infection may lead to numerous complications and should be included among the factors predisposing to worse prognosis. It is especially related to patients with high risk factors and even more important in children as they often pass the infection asymptomatically and its complications can lead to loss of health or life.
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Affiliation(s)
- Anna K. Szewczyk
- Doctoral School, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
- Department of Neurology, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
- Correspondence:
| | - Krystyna Mitosek-Szewczyk
- Department of Child Neurology, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
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Abstract
PURPOSE OF REVIEW We conducted a systematic review of the literature to update findings on the epidemiology and the management of cerebral abscesses in immunocompetent patients. RECENT FINDINGS Observational studies suggest that the overall prognosis has improved over the last decades but mortality rates remain high. Several parameters may contribute to a better prognosis, including the identification of common risk factors for brain abscess, the systematic use of brain MRI at diagnosis, the implementation of appropriate neurosurgical and microbiological techniques for diagnosis, the optimization of the antibacterial treatment based on epidemiology and pharmacokinetic/pharmacodynamic studies, and a long-term follow-up for detection of secondary complications. Outcome research on brain abscess is mainly based on observational studies. Randomized controlled trials have yet to be performed to identify clinically relevant interventions associated with improved patient-centered outcomes. SUMMARY Our review highlights the importance of a multidisciplinary approach to optimize brain abscess management both at the acute phase and in the long-term. Randomized controlled studies are urgently needed to identify interventions associated with improved outcomes.
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Shoap W, Hayden EA, Crabill GA. Persistent brainstem abscess requiring repeat microsurgical drainage: case report. J Surg Case Rep 2021; 2021:rjab376. [PMID: 34476081 PMCID: PMC8407027 DOI: 10.1093/jscr/rjab376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/27/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022] Open
Abstract
In this paper, we present a patient who was treated for a pontine abscess at our institution. This patient underwent sub-occipital craniotomy for microscopic abscess drainage after which cultures grew Streptococcus intermedius. She was treated with antibiotics but failed to show clinical improvement and was taken back to the operating room for repeat abscess drainage. Clinical improvement was seen after the second operation. This case report describes open surgical technique as a safe and effective way of treating brainstem abscess.
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Affiliation(s)
- Wesley Shoap
- Department of Neurosurgery, Louisiana State University, New Orleans, LA, USA
| | - Ellery A Hayden
- Department of Neurosurgery, Louisiana State University, New Orleans, LA, USA
| | - George A Crabill
- Department of Neurosurgery, Louisiana State University, New Orleans, LA, USA
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