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Ahmed H, Khan A, Abdul Rauf S, Somro J, Saleem SEUR, Parvez J. Cerebellar abscess secondary to metastatic lung adenocarcinoma: a case report. J Med Case Rep 2024; 18:389. [PMID: 39169419 PMCID: PMC11340145 DOI: 10.1186/s13256-024-04722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Cerebellar abscesses are rare, life-threatening infections often originating from bacterial sources, while metastatic brain lesions from lung adenocarcinoma are relatively common. However, the coexistence of a cerebellar abscess secondary to metastatic lung adenocarcinoma is exceedingly rare and presents unique diagnostic and management challenges. CASE PRESENTATION We report a case of a 35 year-old Pakistani female patient with persistent headaches, nausea, and vertigo, who was found to have a large cerebellar mass with features suggestive of metastatic lung adenocarcinoma. Further investigation revealed a concomitant cerebellar abscess. Surgical excision and broad-spectrum antibiotics were initiated, resulting in a favorable outcome. CONCLUSION This case showcases the rarity and complexity of cerebellar abscesses due to metastatic lung adenocarcinoma. Timely intervention, including surgery and targeted therapy, is crucial for successful management. Further research is needed to enhance treatment strategies.
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Affiliation(s)
- Hamza Ahmed
- Department of Medicine, Liaquat National Medical College, Karachi, Pakistan
| | - Amanullah Khan
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Sameer Abdul Rauf
- Department of Medicine, Liaquat National Medical College, Karachi, Pakistan.
| | - Javed Somro
- Department of Medicine, Liaquat National Medical College, Karachi, Pakistan
| | | | - Javaria Parvez
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
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2
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Pei X, Zhang Y, Jiang D, Zhang M, Fu J, Niu Y, Tian M, Huang S. Geriatric nutritional risk index has a prognostic value for recovery outcomes in elderly patients with brain abscess. Front Nutr 2024; 11:1410483. [PMID: 39091681 PMCID: PMC11291442 DOI: 10.3389/fnut.2024.1410483] [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] [Received: 04/01/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Background The Geriatric Nutritional Risk Index (GNRI) is a straightforward and objective tool for nutritional screening in older patients and has been demonstrated to possess prognostic predictive value in several diseases. Nonetheless, there is a lack of research on the nutritional risk associated with brain abscess in the older. This study aimed to evaluate the prevalence of nutritional risk among these patients by GNRI and to investigate its potential prognostic value for clinical outcomes. Materials and methods From August 2019 to April 2023, 100 older patients diagnosed with brain abscess were enrolled in this single-center prospective cohort study, which evaluated the prognostic value of the Geriatric Nutritional Risk Index (GNRI) in elderly brain abscess patients. Data collected included demographic, and clinical characteristics at admission and calculated the GNRI, and the Glasgow Outcome Scale (GOS) score 6 months post-discharge. A GOS score of 5 was considered indicative of a good recovery, whereas scores ranging from 1 to 4 were classified as poor recovery. Results The results revealed that 48% of older brain abscess patients were at risk of malnutrition according to the GNRI. These patients had significantly higher post-admission C-reactive protein (CRP) levels (p = 0.017), more comorbidities (p < 0.001), and higher age-adjusted Charlson Comorbidity Index (aCCI) scores (p < 0.001) compared to those without nutritional risk. Spearman correlation analysis showed that GNRI scores were negatively correlated with CRP levels, comorbidities, and aCCI scores, and positively correlated with Glasgow Outcome Scale (GOS) scores (Spearman's ρ = 0.624, p < 0.001). Multivariate logistic regression revealed that lower GNRI values were linked to reduced GOS levels (OR = 0.826, 95% CI: 0.775-0.880). ROC analysis determined a GNRI threshold of 97.50 for predicting poor recovery, with 90.57% sensitivity and 87.23% specificity. Conclusion The older brain abscess patients exhibited a high malnutrition risk. GNRI showed an important predictive value for recovery in older patients, which could be helpful in clinical intervention and rehabilitation.
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Affiliation(s)
- Xu Pei
- Department of Critical Care Medicine and Neurosurgery of Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Yutu Zhang
- Department of General Practice of Huashan Hospital, Fudan University, Shanghai, China
| | - Dongfeng Jiang
- Department of Infectious Diseases of Huashan Hospital, Fudan University, Shanghai, China
| | - Meng Zhang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Junyan Fu
- Department of Radiology of Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Niu
- Department of Clinical Nutrition, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mi Tian
- Department of Critical Care Medicine and Neurosurgery of Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Shanshan Huang
- Department of Clinical Nutrition, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Geriatric of Huashan Hospital, National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China
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Jamalipoursufi G, Hajihashemi A, Sadeghizade S, Geravandi M. Intracranial dissemination of Klebsiella pneumoniae originating from pulmonary infection: a case report. J Med Case Rep 2024; 18:320. [PMID: 39003491 PMCID: PMC11246573 DOI: 10.1186/s13256-024-04653-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/18/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Metastatic brain abscesses caused by Klebsiella pneumoniae are extremely rare but life-threatening conditions. To depict a unique case of the middle-aged hypertensive man with an unusual presentation of metastatic brain abscesses originating from a pleural abscess caused by Klebsiella pneumoniae and subsequently leading to loss of consciousness (LOC). CASE REPORT A 52-year-old Iranian man with a history of hypertension presented to the emergency department with a five-day history of worsening cough, high-grade fever, shortness of breath, chest pain, fatigue, and a productive cough. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and respiratory alkalosis. A chest computed tomography scan confirmed pneumonia, and a brain scan revealed multiple hypodense lesions. Despite antibiotic therapy, the patient's condition worsened, leading to confusion, disorientation, and loss of consciousness. Magnetic resonance imaging revealed multiple ring-enhancing lesions, suggesting an abscess formation. Bronchial washings and BAL samples confirmed a lower respiratory tract infection. Cultures from the bronchial washings grew Klebsiella pneumoniae. CONCLUSIONS Metastatic brain abscesses caused by Klebsiella pneumoniae are exceedingly rare but life-threatening conditions. Timely diagnosis and effective antimicrobial treatment are critical for patient outcomes. This case underscores the significance of recognizing atypical presentations of bacterial infections, as early detection and appropriate management can significantly impact patient outcomes.
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Affiliation(s)
| | - Ali Hajihashemi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shokouh Sadeghizade
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Geravandi
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Fotakopoulos G, Gatos C, Paterakis K, Georgakopoulou VE, Spiliotopoulos T, Christodoulidis G, Sklapani P, Trakas N, Kalogeras A, Fountas KN. Comparison of surgical outcomes between primary and secondary brain abscess. MEDICINE INTERNATIONAL 2024; 4:36. [PMID: 38756455 PMCID: PMC11097135 DOI: 10.3892/mi.2024.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
Brain abscess (BA) constitutes 1-8% of intra-cerebral tumors, and thus the present study aimed to compare the surgical outcomes of patients with primary and secondary BA. The present retrospective study examined 32 of cases BA who underwent surgery in a local institution between February, 2013 and December, 2023. All patients received intravenous antibiotic therapy according to the antibiogram for antimicrobial susceptibility. In total, 32 patients were separated into two groups as follows: Group A (16 patients, 50%) with primary abscess and group B (16 patients, 50%) with secondary abscess. Of the 32 patients included in the study, 23 (71.8%) were males, and the median age was 55.3 years. On the whole, the present study demonstrates that a multidisciplinary approach involving a combination of often multiple surgical procedures and prolonged antibiotic medication may improve the functional outcome if the underlying pathology allows for a functional outcome.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Charalampos Gatos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | | | | | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Adamantios Kalogeras
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Kostas N. Fountas
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
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5
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Scalia G, Ponzo G, Giuffrida M, Patanè D, Riso MF, Garozzo A, Chaurasia B, Umana GE, Nicoletti GF. Stenotrophomonas maltophilia-associated odontogenic cerebral abscess in an immunocompetent patient: A case report. Clin Case Rep 2024; 12:e9168. [PMID: 39005575 PMCID: PMC11239531 DOI: 10.1002/ccr3.9168] [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: 03/26/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Key Clinical Message Stenotrophomonas maltophilia can cause rare odontogenic brain abscesses in immunocompetent patients, highlighting the importance of considering uncommon pathogens in central nervous system infections. With only three reported cases of cerebral abscesses and one pituitary abscess caused by this microorganism, tailored diagnostic methods and individualized treatment regimens are crucial for accurate management. Abstract Brain abscesses present diagnostic and therapeutic challenges, with Stenotrophomonas maltophilia infections being exceptionally rare in the central nervous system. We present a case of odontogenic brain abscesses caused by S. maltophilia in an immunocompetent patient, highlighting the rarity and complexity of such infections. A 66-year-old male presented with spatial-temporal disorientation and left-sided weakness. Radiological investigations revealed an expansive lesion in the right posterior frontal region. A craniotomy and drainage were performed, identifying S. maltophilia in the purulent material. The patient responded well to tailored antibiotic therapy. S. maltophilia-related central nervous system infections are infrequent, emphasizing the need for a heightened clinical suspicion in atypical cases. This case contributes to the literature, emphasizing the importance of a multidisciplinary approach for successful diagnosis and management.
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Affiliation(s)
- Gianluca Scalia
- Neurosurgery Clinic, Department of Head and Neck Surgery Garibaldi Hospital Catania Italy
| | - Giancarlo Ponzo
- Neurosurgery Clinic, Department of Head and Neck Surgery Garibaldi Hospital Catania Italy
| | - Massimiliano Giuffrida
- Neurosurgery Clinic, Department of Head and Neck Surgery Garibaldi Hospital Catania Italy
| | - Domenico Patanè
- Department of Nursing Service Garibaldi Hospital Catania Italy
| | - Marcello Filippo Riso
- Microbiology Section, Department of Biomedical and Biotechnological Sciences University of Catania Catania Italy
| | - Adriana Garozzo
- Microbiology Section, Department of Biomedical and Biotechnological Sciences University of Catania Catania Italy
| | - Bipin Chaurasia
- Department of Neurosurgery Neurosurgery Clinic Birgunj Nepal
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma and Gamma Knife Center Cannizzaro Hospital Catania Italy
- Department of Medicine and Surgery Kore University of Enna Enna Italy
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Eichorn FC, Kameda-Smith M, Fong C, Graham AK, Main C, Lu JQ. Polymicrobial brain abscesses: A complex condition with diagnostic and therapeutic challenges. J Neuropathol Exp Neurol 2024:nlae058. [PMID: 38874452 DOI: 10.1093/jnen/nlae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.
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Affiliation(s)
- Frances-Claire Eichorn
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | | | - Crystal Fong
- Department of Radiology/Neuroradiology, McMaster University, Hamilton, Canada
| | - Alice K Graham
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | - Cheryl Main
- Department of Pathology and Molecular Medicine/Microbiology, McMaster University, Hamilton, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
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Shaik A, Joseph K, Abo Kasem R, Downes A, Janjua MB. Anomalous Left Superior Vena Cava Predisposing to Recurrent Brain Abscesses: A Case Report and Review of the Literature. Cureus 2024; 16:e62329. [PMID: 39006569 PMCID: PMC11246158 DOI: 10.7759/cureus.62329] [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] [Received: 01/30/2024] [Accepted: 06/05/2024] [Indexed: 07/16/2024] Open
Abstract
Brain abscess is a devastating illness, with a high risk of morbidity and mortality. Recurrent brain abscess poses a challenge to diagnosis while treatment options may differ. Right to left shunt is a lesser-explored etiology for recurrent brain abscesses. PubMed literature review was performed to study all published studies with reference to right to left cardiac shunt as a possible etiology for the recurrent brain abscesses. The authors also report a case of a young male who developed recurrent brain abscess after previous resection and treatment. Right to left cardiac shunting of deoxygenated blood is an etiology for recurrent brain abscess formation. Thorough systemic workup and multispecialty treatment is recommended to treat this relatively uncommon presentation.
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Affiliation(s)
- Adnan Shaik
- Neurosurgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Karan Joseph
- Neurosurgery, Washington University School of Medicine, St. Louis, USA
| | - Rahim Abo Kasem
- Neurosurgery, Medical University of South Carolina, Charleston, USA
| | - Angela Downes
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Muhammed B Janjua
- Neurosurgery, Washington University School of Medicine, St. Louis, USA
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8
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Martin SI, Bennett AS, Elliott L, Gorgens KA. Overdose Risk and Brain Injury (Traumatic Brain Injury/Acquired Brain Injury), A Commentary. Subst Use Misuse 2024; 59:1656-1659. [PMID: 38803022 DOI: 10.1080/10826084.2024.2359722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVE This commentary seeks to evaluate existing knowledge about the relationship between brain injury (BI) and overdose (OD), to unify distant bodies of literature, and to enhance prevention and treatment for opioid OD among individuals with BI. BACKGROUND There is a hidden epidemic of undiagnosed BI in the United States. Due to lack of screening, the vast majority of BI sufferers do not know they have a BI. Not only are those with BI at elevated risk for opioid use, misuse, and opioid use disorder, but also they are at elevated risk for OD. Conversely, those with OUD and those who experienced an OD, are more likely to sustain BI. Key Findings/Conclusions: The existing literature suggests that primary strategies to reduce ABI (Acquired Brain Injury)/TBI (Traumatic Brain Injury) harms involve addressing: screening, stigma, racial disparities, and popular misconceptions about OD. The association between TBI and OD is an underexamined public health issue, exacerbated by the bidirectional nature of the relationship. Not only is TBI a risk factor for opioid OD; opioid OD was also found to be a major cause of ABI, which can have lifelong effects similar to Alzheimer's disease. Screening tools for BI were underutilized and inconsistently implemented across reviewed studies. Enhanced screening population wide is a promising intervention, complemented with expanded treatment and research. Black individuals face worse outcomes in BI and treatment outcomes. Anti-racist strategies must fight inequity while addressing social and structural drivers of overdose and BI within the opioid and opioid overdose crises.
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Affiliation(s)
- Samuel I Martin
- Research Associate, School of Global Public Health, New York University, Doctoral Candidate, Graduate School of Professional Psychology, University of Denver
| | - Alex S Bennett
- Research Associate Professor, Center for Drug Use and HIV/HCV Research, School of Global Public Health, New York University
| | - Luther Elliott
- Associate Research Scientist, School of Global Public Health, New York University
| | - Kim A Gorgens
- Professor, Graduate School of Professional Psychology, University of Denver
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Taha MM, Elbadawy MK, Azzam AMN, Taha MM, Alkheder A, Abualkhair KA. Delayed brain abscess as a complication of cerebral infarction: A rare case report and review of the literature. Int J Surg Case Rep 2024; 117:109500. [PMID: 38471206 PMCID: PMC10945269 DOI: 10.1016/j.ijscr.2024.109500] [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: 02/19/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Systemic infections are a common complication of cerebral stroke, while the development of a cerebral abscess on the background of infarcted brain tissue is an extremely rare occurrence. Here, we present a new case alongside a literature review. CASE PRESENTATION A previously healthy 37-year-old man presented with sudden right-sided weakness and speech difficulties, progressing to complete aphasia. Initial tests showed no abnormalities, but subsequent CT scans revealed left basal ganglia infarction. Despite treatment and improvement, three months later, his condition worsened, leading to surgical intervention to excision of a cerebral abscess caused by Staphylococcus aureus. Following successful surgery and treatment, the patient showed improvement and was discharged for regular follow-up care. DISCUSSION The convergence of stroke and brain abscess poses serious clinical challenges, requiring prompt diagnosis and treatment to mitigate catastrophic consequences. Brain abscess, stemming from cerebral infection, may arise from various sources, including contiguous spread, hematogenous dissemination, or traumatic injury. Diagnosis is complicated by nonspecific radiological findings, which often lead to misdiagnosis. Risk factors include age, immunocompromised states, and certain medical conditions. Despite challenges, early detection and appropriate management, involving surgical drainage and antimicrobial therapy, are crucial for favorable outcomes. CONCLUSION Cerebral abscess following cerebral infarction is rare but should be suspected in patients with prior stroke or hemorrhage, experiencing worsening focal deficits and consciousness. Advanced age and comorbidities increase clinical suspicion.
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Affiliation(s)
- Mahmoud M Taha
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | | | - Amr M N Azzam
- Department of Neurosurgery, Zagazig University, Zagazig, Egypt
| | - Mazen M Taha
- Faculty of medicine, Zagazig University, Zagazig, Egypt
| | - Ahmad Alkheder
- Department of Otorhinolaryngology, Al Mouwasat University Hospital, Faculty of Medicine, Damascus University, Damascus, Syria; Faculty of Medicine, Syrian Private University, Damascus, Syria.
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Massimi L, Cinalli G, Frassanito P, Arcangeli V, Auer C, Baro V, Bartoli A, Bianchi F, Dietvorst S, Di Rocco F, Gallo P, Giordano F, Hinojosa J, Iglesias S, Jecko V, Kahilogullari G, Knerlich-Lukoschus F, Laera R, Locatelli D, Luglietto D, Luzi M, Messing-Jünger M, Mura R, Ragazzi P, Riffaud L, Roth J, Sagarribay A, Pinheiro MS, Spazzapan P, Spennato P, Syrmos N, Talamonti G, Valentini L, Van Veelen ML, Zucchelli M, Tamburrini G. Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era. Childs Nerv Syst 2024; 40:1221-1237. [PMID: 38456922 DOI: 10.1007/s00381-024-06332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
| | - G Cinalli
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - V Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Auer
- Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - V Baro
- Pediatric and Functional Neurosurgery, Department of Neurosciences, University of Padova, Padua, Italy
| | - A Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - F Bianchi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Dietvorst
- University Hospitals Leuven, Leuven, Belgium
| | - F Di Rocco
- Hôpital Femme-Mère-Enfant, Université de Lyon, Lyon, France
| | - P Gallo
- Birmingham Children's Hospital, Birmingham, UK
| | - F Giordano
- University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - J Hinojosa
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Iglesias
- Hospital Regional Universitario de Malaga, Malaga, Spain
| | - V Jecko
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - G Kahilogullari
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - F Knerlich-Lukoschus
- Division Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - R Laera
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - D Locatelli
- Neurosurgery Department, Università Dell'Insubria, Ospedale di Circolo e Macchi Foundation, Varese, Italy
| | - D Luglietto
- Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M Luzi
- Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | | | - R Mura
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - P Ragazzi
- Department of Pediatric Neurosurgery, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Turin, Italy
| | - L Riffaud
- Rennes University Hospital, Rennes, France
| | - J Roth
- Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Sagarribay
- Hospital Dona Estefânia-Centro Hospitalar Universitário, Lisboa, Portugal
- Hospital CUF Descobertas, Lisboa, Portugal
| | - M Santos Pinheiro
- Centro Hospitalar Lisboa Norte-Hospital Santa Maria, Lisboa, Portugal
| | - P Spazzapan
- University Medical Center-Ljubljana, Ljubljana, Slovenia
| | - P Spennato
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - N Syrmos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - L Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M L Van Veelen
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - M Zucchelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto Scienze Neurologiche Di Bologna, Boulogne, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
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Sharma B, Sreenivasan P, Singh A, Mondal PS, Ray P, Angrup A. Otogenic Cerebellar Abscess with Polymicrobial Anaerobic Infection in a Young Female- A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2024; 76:1195-1198. [PMID: 38440584 PMCID: PMC10908990 DOI: 10.1007/s12070-023-04218-x] [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: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 03/06/2024] Open
Abstract
Brain abscess is a serious clinical condition caused by a localized collection of pus within the brain tissue. This typically occurs as a result of an infection that originates from a nearby area, such as an ear, sinus, or dental infection, or an infection in the bloodstream. Streptococcus and Staphylococcus species are the most common organisms implicated in brain abscesses. Apart from aerobic growth, cases of mixed infections of both aerobic and anaerobic organisms are also commonly reported in the literature. Herein we report a 23-year-old immunocompetent female with chronic otitis media who presented with cerebellar abscess where the aerobic growth was sterile and anaerobic culture revealed pure growth of dual anaerobes viz… Peptostreptococcus and Bacteroides thetaiotaomicron. This case highlights the importance of prompt diagnosis and management of polymicrobial anaerobic infection in cases of brain abscess.
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Affiliation(s)
- Bhawna Sharma
- Department of Medical Microbiology, AIIMS, Bathinda, India
| | - Priya Sreenivasan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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12
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Dragomir RM, Mattner O, Hagan V, Swerdloff MA. Listeria monocytogenes Brain Abscess Presenting With Stroke-Like Symptoms: A Case Report. Cureus 2024; 16:e52216. [PMID: 38347999 PMCID: PMC10859722 DOI: 10.7759/cureus.52216] [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] [Received: 11/03/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
We present a case of Listeria monocytogenes brain abscess in an immunocompromised patient admitted for stroke-like symptoms of headache and aphasia. Computerized tomography of the head revealed a 1.7 x 1.3 cm left frontal lobe lesion with surrounding edema, secondary to stroke, tumor, or abscess. Magnetic resonance imaging brain revealed a ring-enhancing lesion and a small contralateral area of restricted diffusion. Two of the two blood cultures grew an organism identified as L. monocytogenes using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Treatment with ampicillin and trimethoprim-sulfa yielded marked symptomatic improvement. A brain biopsy was consistent with bacterial abscess. The patient's clinical course was favorable, with improved aphasia and negative follow-up blood cultures. A literature review found a limited number of L. monocytogenes abscess cases and none had clear guidelines for diagnosis. Recent studies have proposed five criteria for diagnosis. Our patient fulfilled three of these proposed guidelines.
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Affiliation(s)
- Roxana M Dragomir
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Olivia Mattner
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Veronica Hagan
- Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Marc A Swerdloff
- Neurology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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13
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Swied MY, Alom M, Daaboul O, Azzawi M, Swied A. Esophageal Perforation Presenting Initially as Multiple Brain Abscesses Secondary to Streptococcus intermedius. J Investig Med High Impact Case Rep 2024; 12:23247096241239572. [PMID: 38504423 PMCID: PMC10953314 DOI: 10.1177/23247096241239572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/13/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
Brain abscess is a life-threatening infection that can occur secondary to contiguous or hematogenous spread. Several underlying conditions can lead to brain abscesses, such as dental infection, otitis media, sinusitis, and immunosuppression. Esophageal perforation leading to brain abscesses is extremely rare. We report a rare case of a 32-year-old man who presented to the emergency department with progressive headaches and upper-extremity weakness. Upon further evaluation, computed tomography (CT) revealed multiple brain abscesses secondary to Streptococcus intermedius infection. The patient eventually underwent esophagogastroduodenoscopy (EGD), which showed a perforation in the middle third of the esophagus. This case highlights the importance of considering esophageal perforation as a predisposing condition for brain abscesses.
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Affiliation(s)
| | - Mulham Alom
- Southern Illinois University School of Medicine, Springfield, USA
| | - Obada Daaboul
- Southern Illinois University School of Medicine, Springfield, USA
| | - Muaataz Azzawi
- Southern Illinois University School of Medicine, Springfield, USA
| | - Abdul Swied
- Southern Illinois University School of Medicine, Springfield, USA
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14
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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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15
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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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16
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Mantova MC, Moya BT. A thalamic brain abscess in an immunocompetent patient. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 38153023 DOI: 10.12968/hmed.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Maria C Mantova
- Department of Acute Medicine, King's College Hospital, London, UK
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17
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Mahmoud A, Beliani T, Alyassin N, Zakharia K, Basil T, Poulad D. Streptococcus intermedius: From a Normal Oral Commensal to a Life-Threatening Organism. Cureus 2023; 15:e50708. [PMID: 38234954 PMCID: PMC10792467 DOI: 10.7759/cureus.50708] [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: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Subdural empyema is a collection of pus in the subdural space between the dura mater and the arachnoid. It carries very high morbidity and mortality as it can spread anywhere in the brain; however, the risk can be mitigated with appropriate surgical and medical intervention. Being protected by the skull, cranial infections are usually preceded by a significant risk factor, either an external invader such as skull fractures secondary to trauma, penetrating injury, prior surgery, or, more commonly, in more than 50% of cases, due to spread of an internal infection such as ear or sinus infections. Anaerobic and aerobic bacteria can cause subdural empyema. Both gram-positive and gram-negative bacteria are notorious for developing this kind of infection; for example, different groups of gram-positive streptococci and staphylococci, gram-negative Haemophilus influenza, and other gram-negative bacilli can cause subdural empyema. While streptococci are more frequent with sinus infection causing subdural empyema, staphylococci are associated with skin invasion secondary to either head trauma or cranial surgery. Streptococcus intermedius is a gram-positive alpha-hemolytic pathogen belonging to the larger Streptococcus anginosus group that itself is a subgroup from viridans streptococci, aka Streptococcus milleri. Streptococcus intermedius is an oral commensal flora and is considered to be a low-virulence bacteria in immunocompetent patients but can be associated with significant morbidity and mortality. Subdural empyema tends to occur more often in immunocompromised patients such as diabetic patients, those with human immunodeficiency virus infection, and those using immunosuppressive medications. The clinical course ranges from indolent to fulminant. The size and location of the abscess play a role in clinical presentation. Headache is the most common presenting symptom, but patients can also present with fever, nausea, seizure, or altered mental status. Diagnosis can be obtained with CT and MRI scans of the brain. Prompt drainage of the abscess and lengthy antibiotics improve the prognosis significantly. Our case highlights a rare origin of subdural empyema from the direct spread of a skin abscess.
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Affiliation(s)
- Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Tala Beliani
- Oncology, Kansas City University, Kansas City, USA
| | - Nizar Alyassin
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Karam Zakharia
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Taha Basil
- Infectious Disease, St. Joseph's University Medical Center, Paterson, USA
| | - David Poulad
- Neurosurgery, St. Joseph's University Medical Center, Paterson, USA
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18
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Corbisiero MF, Ripperton RA, Creighton EG, Smyth AM, Beckham JD, Henao-Martínez AF. Brain Abscesses in the Tropics. CURRENT TROPICAL MEDICINE REPORTS 2023; 10:235-243. [PMID: 38947183 PMCID: PMC11212790 DOI: 10.1007/s40475-023-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 07/02/2024]
Abstract
Purpose of Review This review aims to elucidate the etiologies of brain abscesses in the tropics. Despite the similarities in causes of brain abscesses across global regions, tropical settings manifest distinguishing characteristics, prominently observed on computed tomography or magnetic resonance imaging. Recent Findings In tropical climates, the leading conditions predisposing individuals to brain abscesses are polymicrobial bacterial infections originating from paranasal sinuses, dental sources, and otitis media. However, the tropics present unique etiologies to be aware of, including Trypanosoma cruzi (Chagas disease), free-living amoebas like Balamuthia mandrillaris, infections from Burkholderia pseudomallei (melioidosis), fungi such as Talaromyces marneffei, and Mycobacterium tuberculosis. Given the differential diagnoses, which include neoplastic, inflammatory, and demyelinating diseases, a stereotactic biopsy coupled with a microbiological assessment remains valuable for accurate diagnosis. Summary In tropical regions, brain abscesses are a concern when confronted with mass-occupying or other types of brain lesions. Successful clinical management of brain abscesses typically combines surgical intervention and extended anti-microbial treatment. However, specific parasitic invasions like Chagas disease, free-living amoebas, and Entamoeba histolytica necessitate targeted anti-parasitic therapies. Furthermore, international policy efforts should focus on prevention measures in resource limited regions with heightened risks and disease burden.
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Affiliation(s)
| | | | | | | | - J. David Beckham
- Division of Infectious Diseases and Geographic Medicine, Southwestern Medical Center, UT, Dallas, TX, USA
| | - Andres F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado Denver, Anschutz Medical Campus, Denver, CO, USA
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Kameda-Smith MM, Mendoza M, Brown LA, Hartley J, Aquilina K, James G, Jeelani NO, Silva AHD, Thompson D, Tisdall M, Tahir MZ, Hatcher J. Comparison of endoscopic sinus sampling versus intracranial sampling for microbiological diagnosis of intracranial infection in children: a case series and literature review. Childs Nerv Syst 2023; 39:3561-3570. [PMID: 37368066 DOI: 10.1007/s00381-023-06038-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Intracranial infection is often associated with contiguous sinus infection, with Streptococcus intermedius being the most common pathogen. Microbiological assessment is possible via sinus or intracranial sampling. While a sinus approach is minimally invasive, it is not clear whether this yields definitive microbiological diagnosis leading to optimized antimicrobial therapy and avoidance of intracranial surgery. METHODS A retrospective review of a prospectively collected electronic departmental database identified patients between 2019 and 2022. Further demographic and microbiological information was obtained from electronic patient records and laboratory management systems. RESULTS Thirty-one patients were identified with intracranial subdural and/or epidural empyema and concurrent sinus involvement during the 3-year study period. The median age of onset was 10 years with a slight male predominance (55%). All patients had intracranial sampling with 15 patients undergoing sinus sampling in addition. Only 1 patient (7%) demonstrated identical organism(s) grown from both samples. Streptococcus intermedius was the most common pathogen in intracranial samples. Thirteen patients (42%) had mixed organisms from their intracranial cultures and 57% of samples undergoing bacterial PCR identified additional organisms, predominantly anaerobes. Sinus samples had a significant addition of nasal flora and Staphylococcus aureus which was rarely grown from intracranial samples. Of concern, 7/14 (50%) of sinus samples did not identify the main intracranial pathogen diagnosed on intracranial culture and additional PCR. Literature review identified 21 studies where sinus drainage was used to treat intracranial empyemas, with only 6 authors reporting concurrent microbiology results. This confirmed our cohort to be the largest comparative study in the current literature. No center has observed a greater than 50% concordance in microbiological diagnoses. CONCLUSION Endoscopic sinus surgery may have therapeutic benefit, but it is not an appropriate approach for microbiological diagnosis in pediatric subdural empyemas. High rates of contaminating nasal flora can lead to misdiagnosis and inappropriate treatment. Routine addition of 16S rRNA PCR to intracranial samples is recommended.
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Affiliation(s)
- Michelle Masayo Kameda-Smith
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
| | - Maya Mendoza
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Li-An Brown
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK
| | - John Hartley
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK
| | - Kristian Aquilina
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Greg James
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Noor Owase Jeelani
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Dominic Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Martin Tisdall
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK.
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
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Fernández Vecilla D, Roche Matheus MP, Urrutikoetxea Gutiérrez M, Iglesias Hidalgo G, Aspichueta Vivanco C, Díaz de Tuesta Del Arco JL. Brain abscess caused by Porphyromonas gingivalis and Eubacterium nodatum mimicking acute stroke. Anaerobe 2023; 84:102801. [PMID: 38007215 DOI: 10.1016/j.anaerobe.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
We described a case of a 65-year-old man with a brain abscess caused by Porphyromonas gingivalis and Eubacterium nodatum. The patient presented right central facial nerve palsy, mutism and right hemiparesis at the examination. The patient underwent a left frontal craniotomy with evacuation of the brain abscess. Specimens were collected for microbiological analysis and intravenous treatment was started with levetiracetam, dexamethasone, meropenem (1 g/8 h) and linezolid (600 mg/12 h). After identification of anaerobic bacteria the antibiotic treatment was changed to piperacillin/tazobactam (4 g/0,5 g/8 h), fulfilling 8 weeks of antibiotic with good clinical and radiological evolution.
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Affiliation(s)
- Domingo Fernández Vecilla
- Clinical Microbiology Service, Laredo Regional Hospital, Av. Derechos Humanos, 40, 39770, Laredo, Cantabria, Spain.
| | - Mary Paz Roche Matheus
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | - Mikel Urrutikoetxea Gutiérrez
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | | | - Cristina Aspichueta Vivanco
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | - José Luis Díaz de Tuesta Del Arco
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
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21
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Argie D, Lukito PP, Soegianto SDP, Tiluata LJ, Lauren C. Management of cerebral abscess with large ventricular septal defect in rural area: a case report. J Surg Case Rep 2023; 2023:rjad703. [PMID: 38164210 PMCID: PMC10758247 DOI: 10.1093/jscr/rjad703] [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] [Received: 10/31/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024] Open
Abstract
Cerebral abscess is an uncommon complication of cyanotic heart disease. However, it has a high case fatality rate, and its management requires a multidisciplinary approach. Earlier diagnosis would result in a better outcome. In this report, we presented a case of a 6-year-old boy with a cerebral abscess and a large ventricular septal defect, which was treated surgically in a rural area with a limited resources facility.
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Affiliation(s)
- Donny Argie
- Department of Surgery sub Neurosurgery, Faculty of Medicine, RSUD WZ Johannes Kupang, Universitas Nusa Cendana, East Nusa Tenggara 85111, Indonesia
| | - Patrick Putra Lukito
- Department of Surgery sub Neurosurgery, Faculty of Medicine, RSUD WZ Johannes Kupang, Universitas Nusa Cendana, East Nusa Tenggara 85111, Indonesia
| | - Sugi Deny Pranoto Soegianto
- Department of Paediatrics, Faculty of Medicine, RSUD WZ Johannes Kupang, Universitas Nusa Cendana, East Nusa Tenggara 85111, Indonesia
| | - Leonora Johana Tiluata
- Department of Cardiology, Faculty of Medicine, RSUD WZ Johannes Kupang, Universitas Nusa Cendana, East Nusa Tenggara 85111, Indonesia
| | - Christopher Lauren
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali 80113, Indonesia
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Kawamoto S, Harada Y, Hiyama T, Sueoka K, Kishi Y, Mitsuhara T, Kihara K, Kiuchi Y. Orbital fibrous capsule formation with abscess found 3 years after penetrating injury from a wooden chopstick. Orbit 2023:1-6. [PMID: 37902564 DOI: 10.1080/01676830.2023.2269237] [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: 06/19/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023]
Abstract
Intraorbital wooden foreign bodies are sometimes difficult to diagnose because of nonspecific clinical manifestations and diversity of imaging characteristics. We herein report a case involving a 72-year-old woman with a history of trauma induced by a coated wooden chopstick 3 years prior. Two years after the incident, computed tomography (CT) scan revealed an intraorbital mass that was initially diagnosed as an intraorbital hemangioma. The patient presented with hyperemia, impairment of ocular movement, and optic neuropathy in her right eye. Magnetic resonance imaging (MRI) showed granulation tissue and an abscess around a foreign body, which was compressing the eyeball. Surgical extraction of the foreign body was performed, leading to resolution of symptoms. The depiction of wooden foreign bodies by imaging is complicated and affected by several factors, increasing the risk of delayed diagnosis. To avoid permanent sequelae, MRI might be helpful because its imaging capabilities are superior to those of CT.
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Affiliation(s)
- Saori Kawamoto
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yosuke Harada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomona Hiyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Kentaro Sueoka
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasumasa Kishi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Kihara
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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23
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Chaganti SS, Sidhom G, Chaganti J. Multiparametric imaging in the evaluation of intracerebral abscesses. Pract Neurol 2023; 23:376-385. [PMID: 37248041 DOI: 10.1136/pn-2023-003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with non-specific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment.
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Affiliation(s)
- Sai Sivananda Chaganti
- Fellow, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - George Sidhom
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- Department of Radiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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24
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Kavya S, Arvinda HR, Veenakumari HB, PrabuRaj AR, Smitha NR, Jyothi D, Dwarakanath S, Nagarathna S. Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance. Indian J Med Microbiol 2023; 45:100395. [PMID: 37573041 DOI: 10.1016/j.ijmmb.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 08/14/2023]
Abstract
AIMS • To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess. • To understand the risk factors for the same. • To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. METHODS This is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FINDINGS A total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. CONCLUSION SAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.
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Affiliation(s)
- S Kavya
- Department of Neuromicrobiology, NIMHANS, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | | | - N R Smitha
- Department of Neuromicrobiology, NIMHANS, India
| | | | | | - S Nagarathna
- Department of Neuromicrobiology, NIMHANS, India.
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25
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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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26
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Kimura T. Case report on successful treatment for brain abscess in a Japanese monkey (Macaca fuscata). Lab Anim Res 2023; 39:13. [PMID: 37296447 DOI: 10.1186/s42826-023-00165-4] [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: 01/06/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND A brain abscess in human beings is a focal infection of the central nervous system frequently characterized by areas of localized cerebritis and central necrosis surrounded by a well vascularized capsule. A brain abscess, although sporadically reported, is relatively rare disease in domestic animals (horses, cattle, goats and alpacas), companion animals (dogs and cats) and laboratory nonhuman primates. Brain abscesses are life threatening disease that needs early and aggressive veterinary therapy. CASE PRESENTATION The purpose of this study on a brain abscess in a Japanese monkey was to report the investigational and therapeutic processes including clinical observations, hematological and serum biochemical profiles, and magnetic resonance imaging (MRI) features, probiotic and antibiotic therapy. In clinical observation, the monkey presented with slowly progressive gentle and depressed behavioral change. Hematological findings showed that slightly declined platelet counts gradually increased in the course of the treatment. Serum biochemical profiles revealed initial markedly elevated. A series of chemotherapy provide prominent relief from the influence of the brain abscess. MRI images illustrated that a brain abscess was located in the right frontal lobe and the mass was delineated by a thick rim, indicating the capsule formation stage. The lesion chronologically decreased in size over the course of treatment. Until 11 weeks after treatment of the brain abscess, the size of brain abscess continued to reduce, leaving an organized lesion trace. To the best of my knowledge, this is the first report on successful treatment for a brain abscess in a Japanese monkey (Macaca fuscata). CONCLUSIONS Medical management of simian brain abscesses is possible based on the controlled and resolving nature of the lesions as determined by MRI and completion of a of chemical antibiotic treatment presented in this study.
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Affiliation(s)
- Tohru Kimura
- Laboratory Animal Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, 1677-1, Yoshida, Yamaguchi, 753-8515, Japan.
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27
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Su J, Hu B, Zhang Y, Li Y. Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China. Heliyon 2023; 9:e16003. [PMID: 37215846 PMCID: PMC10192766 DOI: 10.1016/j.heliyon.2023.e16003] [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: 09/27/2022] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Background Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms. Methods A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected. Results Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P = 0.016). Conclusions Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.
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Affiliation(s)
- Jiachun Su
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Hu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
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28
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Surianarayanan C, Lawrence JJ, Chelliah PR, Prakash E, Hewage C. Convergence of Artificial Intelligence and Neuroscience towards the Diagnosis of Neurological Disorders-A Scoping Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3062. [PMID: 36991773 PMCID: PMC10053494 DOI: 10.3390/s23063062] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/19/2023]
Abstract
Artificial intelligence (AI) is a field of computer science that deals with the simulation of human intelligence using machines so that such machines gain problem-solving and decision-making capabilities similar to that of the human brain. Neuroscience is the scientific study of the struczture and cognitive functions of the brain. Neuroscience and AI are mutually interrelated. These two fields help each other in their advancements. The theory of neuroscience has brought many distinct improvisations into the AI field. The biological neural network has led to the realization of complex deep neural network architectures that are used to develop versatile applications, such as text processing, speech recognition, object detection, etc. Additionally, neuroscience helps to validate the existing AI-based models. Reinforcement learning in humans and animals has inspired computer scientists to develop algorithms for reinforcement learning in artificial systems, which enables those systems to learn complex strategies without explicit instruction. Such learning helps in building complex applications, like robot-based surgery, autonomous vehicles, gaming applications, etc. In turn, with its ability to intelligently analyze complex data and extract hidden patterns, AI fits as a perfect choice for analyzing neuroscience data that are very complex. Large-scale AI-based simulations help neuroscientists test their hypotheses. Through an interface with the brain, an AI-based system can extract the brain signals and commands that are generated according to the signals. These commands are fed into devices, such as a robotic arm, which helps in the movement of paralyzed muscles or other human parts. AI has several use cases in analyzing neuroimaging data and reducing the workload of radiologists. The study of neuroscience helps in the early detection and diagnosis of neurological disorders. In the same way, AI can effectively be applied to the prediction and detection of neurological disorders. Thus, in this paper, a scoping review has been carried out on the mutual relationship between AI and neuroscience, emphasizing the convergence between AI and neuroscience in order to detect and predict various neurological disorders.
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Affiliation(s)
| | | | | | - Edmond Prakash
- Research Center for Creative Arts, University for the Creative Arts (UCA), Farnham GU9 7DS, UK
| | - Chaminda Hewage
- Cardiff School of Technologies, Cardiff Metropolitan University, Cardiff CF5 2YB, UK
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29
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Narayanan V, Narayan V, Jaswal S, M Sethuraman R, Mahajan S. Anesthetic management of brain abscess with cyanotic congenital heart disease: Two case reports. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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30
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Evans TJ, Jawad S, Kalyal N, Nadarajah A, Amarouche M, Stapleton S, Ward C, Breathnach A. Retrospective review of the epidemiology, microbiology, management and outcomes of intra-cranial abscesses at a neurosurgical tertiary referral centre, 2018-2020. Ann Clin Microbiol Antimicrob 2022; 21:58. [PMID: 36575518 PMCID: PMC9795649 DOI: 10.1186/s12941-022-00550-2] [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] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intracranial abscesses are rare but serious, and are associated with significant morbidity and mortality. Due to both the rarity and severity of these infections, well-controlled trials have not been reported in the literature, and optimal management is a matter for expert opinion. Advances in surgical management have improved outcomes and increased rates of microbiological diagnosis. However, the approach to antimicrobial chemotherapy varies considerably, including the choice of antibiotic, the duration of treatment, and the timing of oral switch. METHODS We conducted a retrospective review of 43 cases of intracranial abscesses from a large, tertiary neurosurgical centre in London, UK, between 2018 and 2020, including 29 primary intra-parenchymal abscesses, 11 subdural abscesses and 3 extradural abscesses. RESULTS The majority of cases had surgical intervention; 6/43 (14%) required repeat intervention (all intra-parenchymal abscesses). A microbiological diagnosis was made in 83% of cases. Intravenous antibiotics were given for a median of 33 days (IQR 23-44 days), with a variable duration of oral follow-on antibiotics. Total duration of antibiotic treatment ranged from 0 to 467 days. Only three patients from our cohort are known to have died. CONCLUSION Shorter courses of intravenous antibiotics for brain abscesses were not associated with increased mortality. In the absence of well-controlled trials, a national registry of intracranial abscesses would provide invaluable data to inform optimal treatment.
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Affiliation(s)
- Terry John Evans
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Jawad
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nida Kalyal
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Angelina Nadarajah
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Meriem Amarouche
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Simon Stapleton
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Christopher Ward
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Aodhan Breathnach
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
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31
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Muacevic A, Adler JR, Goldfarb M, Ahmad F. Multifocal Brain Abscesses Due to Streptococcus intermedius. Cureus 2022; 14:e32797. [PMID: 36694540 PMCID: PMC9858951 DOI: 10.7759/cureus.32797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Brain abscess is a life-threatening illness that occurs when an intracerebral infection leads to cerebritis and subsequent pus formation within a well-vascularized capsule. While streptococci (aerobic, anaerobic, and microaerophilic) are the most common bacteria isolated, its presentation as multifocal brain abscesses is rarely described. In this report, we describe a 43-year-old male patient who presented to the emergency department due to progressive lethargy and low-grade fever of seven days worsening. Upon further evaluation, the patient was found to have multiple brain abscesses secondary to Streptococcus intermedius, confirmed by the culture of stereotactic aspiration of brain collection. This case underlines the importance of considering Streptococcus intermedius as a cause of multifocal brain abscesses.
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32
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Şahin S, Menekşe Ş. Recurrent Nocardial Brain Abscess Developing in an Immunocompetent Patient, A Case Report. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:280-284. [PMID: 38633720 PMCID: PMC10986689 DOI: 10.36519/idcm.2022.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/10/2022] [Indexed: 04/19/2024]
Abstract
Central nervous system nocardiosis is rare but has high morbidity and mortality. Immunocompromised patients who have malignancies such as lymphoma, infections such as human immunodeficiency virus (HIV), and bone marrow or solid organ recipients are particularly vulnerable to infection. However, here, we present a patient who developed nocardiosis and recurrent brain abscesses despite having no immunodeficiency problems. The abscess recurred despite total abscess excision and parenteral therapy. After nocardiosis was diagnosed, intravenous treatment with imipenem and amikacin was initiated. The patient was discharged on oral doxycycline. In our immunocompetent case, the abscess recurred four times, resulting in death.
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Affiliation(s)
- Suzan Şahin
- Infectious Disease and Clinic Microbiology Department, Kartal Dr. Lütfi Kirdar City Hospital, İstanbul, Turkey
| | - Şirin Menekşe
- Infectious Disease and Clinic Microbiology Department, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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33
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Lannon M, Trivedi A, Martyniuk A, Farrokhyar F, Sharma S. Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis. Br J Neurosurg 2022; 36:743-749. [PMID: 36062586 DOI: 10.1080/02688697.2022.2118231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brain abscesses are associated with considerable morbidity and mortality, requiring timely intervention to achieve favourable outcomes. With the advent of high-resolution computed tomography (CT) imaging, mortality following both aspiration and excision of brain abscesses has improved markedly. As a result, there has been a marked shift in neurosurgical practice with aspiration eclipsing excision as the favoured first-line modality for most abscesses. However, this trend lacks sufficient supporting evidence, and this systematic review and meta-analysis seeks to compare aspiration and excision in the treatment of brain abscess. Twenty-seven studies were included in the systematic review, and seven comparative papers in meta-analysis. Aspiration was the chosen technique for 67.5% of patients. Baseline characteristics from the studies included only in the systematic review demonstrated that abscesses treated by aspiration were typically larger and in a deeper location than those excised. In the meta-analysis, we initially found no significant difference in mortality, re-operation rate, or functional outcome between the two treatment modalities. However, sensitivity analysis revealed that excision results in lower re-operation rate. On average, the included studies were of poor quality with average Methodological Index for Non-Randomized Studies (MINORS) scores of 10.3/16 and 14.43/24 for non-comparative and comparative papers respectively. Our study demonstrates that excision may offer improved re-operation rate as compared to aspiration for those abscesses where there is no prior clinical indication for either modality. However, no differences were found with respect to mortality or functional outcome. Evidence from the literature was deemed low quality, emphasizing the need for further investigation in this field, specifically in the form of large, well-controlled, comparative trials.
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Affiliation(s)
- Melissa Lannon
- Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Arunchala Trivedi
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - Forough Farrokhyar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Canada
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34
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Chen M, Lai Z, Cheng M, Liang T, Lin Z. Rare brain and pulmonary abscesses caused by oral pathogens started with acute gastroenteritis diagnosed by metagenome next-generation sequencing: A case report and literature review. Front Cell Infect Microbiol 2022; 12:949840. [PMID: 36250052 PMCID: PMC9561126 DOI: 10.3389/fcimb.2022.949840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Odontogenic brain and pulmonary abscesses are extremely rare infectious diseases. It is mainly caused by the upward or downward transmission of local infection or blood-borne spread. In recent years, with the wide application of some novel testing methods in clinical practice, the diagnosis of unexplained infections such as odontogenic abscesses in different organs has gradually become clear. We report a case of a 21-year-old male who was healthy and had not received any oral treatment before onset. He started with acute gastroenteritis-related symptoms, then developed meningitis-related symptoms seven days later with septic shock. No obvious abscess lesions were found on head computed tomography (CT) at admission, and the etiology was not clear by routine examination, which was very easy to misdiagnose as a serious infection caused by intestinal pathogens. But odontogenic pathogens were found both in his blood and cerebrospinal fluid through metagenomic next-generation sequencing (mNGS) analysis. Subsequently, rechecked imaging examination displayed multiple brain and pulmonary abscesses. Finally, it was diagnosed as an odontogenic brain and pulmonary abscess. After an extremely lengthy anti-infection course (13 weeks of intravenous antibiotics plus 2 weeks of oral antibiotics) and surgery, the patient was improved and discharged from the hospital. From this case, we could see that the development of new diagnostic technologies such as mNGS plays an important role in the early and confirmed diagnosis of diseases previously difficult to diagnose such as odontogenic polymicrobial infections and ultimately helps to improve the prognosis of these patients.
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Affiliation(s)
- Minhua Chen
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Zhiyi Lai
- Intensive Care Unit, Ningbo Fourth Hospital (The Affiliated Xiangshan Hospital of Wenzhou Medical University), Ningbo, China
| | - Mingjun Cheng
- Intensive Care Unit, Chun’an First People’s Hospital (Chun’an Branch of Zhejiang Provincial People’s Hospital and Chun’an Hospital Affiliated to Hangzhou Medical College), Hangzhou, China
| | - Tianyu Liang
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
| | - Zongbin Lin
- Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- *Correspondence: Zongbin Lin, ; Tianyu Liang,
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35
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Marcucci M, Papiri G, Tagliati C, Fogante M. Diffusion-weighted imaging in the early diagnosis of intraventricular rupture of a brain abscess. Radiol Case Rep 2022; 17:3059-3063. [PMID: 35769116 PMCID: PMC9234537 DOI: 10.1016/j.radcr.2022.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
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36
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Kameda-Smith MM, Duda T, Duncan DB, Ragulojan M, Jung Y, Farrokhyar F, Main C, Reddy K. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review. World Neurosurg 2022; 165:e697-e711. [PMID: 35798293 DOI: 10.1016/j.wneu.2022.06.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. METHODS A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. RESULTS We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. CONCLUSIONS Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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Affiliation(s)
| | - Taylor Duda
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donald B Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Yongkyung Jung
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Main
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Cerebral abcess of dental origin about a case in the department of stomatology maxillofacial surgery of university hospital center Yalgado Ouedraogo. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Srichawla BS. Plasma Microbial Cell-Free DNA (CF-DNA) Next-Generation Sequencing in Diagnosing Intracranial Abscesses: Pathophysiology and a Scoping Review of the Literature. Cureus 2022; 14:e28172. [PMID: 36148190 PMCID: PMC9482791 DOI: 10.7759/cureus.28172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
Plasma microbial cell-free DNA (cf-DNA) from next-generation sequencing (NGS) provides improved sensitivity and specificity compared to standard microbial blood cultures. cf-DNA sequencing also has an improved turnaround time (TAT) and allows quicker commencement of antibiotics in life-threatening infections such as a brain abscess. Brain abscesses carry significant morbidity and mortality. Empiric treatment and management are critical in improving functional neurological outcomes. Reported here is the case of a severe central nervous system (CNS) infection with multiple ring-enhancing lesions seen throughout the cerebrum on magnetic resonance imaging (MRI). Standard microbial blood cultures were inconclusive and definitive identification of the pathogen was achieved through microbial cf-DNA NGS. Brain abscesses develop in four distinct phases: early cerebritis, late cerebritis, early capsule formation, and late capsule formation. The pathogenesis of cerebral abscess involves direct parenchymal inflammation of the pathogen, the recruitment of inflammatory CNS cell types (microglia, inflammatory astrocytes, etc), and the chemotaxis of immune cells. cf-DNA is released into the bloodstream in response to pathogen opsonization and immune-mediated cell death. A scoping literature review includes cases of intracranial abscesses diagnosed via cf-DNA NGS.
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Chetty M, Rakhi B, Rachana K, Sujatha S, Srinivasan GM. An Eight Year Clinico-Microbiological Retrospective Study on Brain Abscesses in India. Microbiol Insights 2022; 15:11786361221106111. [PMID: 35784588 PMCID: PMC9247994 DOI: 10.1177/11786361221106111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Intracranial abscesses have been a diagnostic and therapeutic challenge since
time immemorial for both the microbiologists and the neurosurgeons. There is
paucity of detailed studies documenting the infecting organism causing brain
abscesses in South India. Aims: The study aimed at identifying and assessing the prevalence of aerobic,
anaerobic bacteria and fungi associated with brain abscesses at a tertiary
care hospital in South India. Methods and Material: Eight years data was collected from the records of culture reports from 2007
to 2010 and 2013 to 2018. The corresponding clinical case records were
retrieved for the assessment of risk factors. Risk factors of brain abscess
development were assessed based on clinical cases records. Results: Data from 140 brain abscess cases obtained over a period of 8 years were
analyzed. Out of the 140 samples, 66 (47.14%) were culture positive in which
33 (50%) had single aerobic/facultative anaerobic bacteria, 20 (30.3%) had
mixture of more than one aerobic/facultative anaerobic bacteria, 12 (18.18%)
had single obligate anaerobic bacteria and 1(1.5%) sample had
Mycobacterium tuberculosis isolated. Among the total 92
isolates, Pseudomonas aeruginosa (21/92, 23%) and
Staphylococcus aureus (20/92, 22%) predominated.
Bacteroides fragilis group was the most common obligate
anaerobe isolated. There were no fungal isolates. As there were various
isolates isolated, hence there is heterogeneity of isolates detected
Neuroanatomically, parietal lobe (45/140, 32%) was the most common location.
Otogenic infection was the major risk factor for parietal and temporal lobe
abscess (P value < .05). Conclusions: It has become essential for the microbiologists to be aware of unusual
isolates from brain abscess and its complex nature. Obscurity and difficulty
in their microbiological diagnosis calls for more such detailed studies.
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Affiliation(s)
- Meghna Chetty
- Department of Microbiology, PIMS, Kalapet, Puducherry, India
| | - Biswas Rakhi
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kannambath Rachana
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sistla Sujatha
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gopalkrishnan Muthu Srinivasan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kinoshita O, Okamoto T, Ota T, Takayama S, Oi Y, Tanaka S, Taniyama I, Naito K, Inoue Y. Klebsiella invasive liver abscess syndrome presenting with a central nervous system manifestation secondary to latent cholecystitis: a case report. J Med Case Rep 2022; 16:234. [PMID: 35672831 PMCID: PMC9175309 DOI: 10.1186/s13256-022-03325-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Brain abscess is a life-threatening event. Moreover, when Klebsiella pneumoniae is the cause, rapid diagnosis and appropriate treatment are required. Klebsiella invasive liver abscess syndrome, a bloodstream metastatic infection of potentially aggressive nature, has been recognized to cause infection in the central nervous system, and concern for Klebsiella liver abscess syndrome is increasing globally. Case presentation A 73-year-old Japanese woman was admitted to the institution complaining of aggravated dysarthria and weakness in the right upper extremities with onset 5 days earlier. Magnetic resonance imaging revealed a brain abscess in the left basal ganglia, and abdominal computed tomography revealed a liver abscess in liver segment 7. The patient’s dysarthria symptoms became increasingly worse over the next few days, so surgical drainage via frontotemporal craniotomy was performed on admission day 3, and subsequent culture from the brain abscess showed growth of Klebsiella pneumoniae. On admission day 9, percutaneous transhepatic drainage of the liver segment 7 abscess was undertaken. The pus culture also showed growth of Klebsiella pneumoniae, thus associating the liver abscess with the brain abscess. Following long-term conservative treatment with antibiotics and abscess drainage, the liver abscess disappeared. However, the patient continuously presented with right upper quadrant pain, and abdominal computed tomography showed swelling of the gallbladder. Consequently, percutaneous transhepatic gallbladder drainage was initially administered, and the bile culture was also positive for Klebsiella pneumoniae. For radical treatment, a laparoscopic cholecystectomy was performed on admission day 99. The postoperative period was complicated by an intraabdominal abscess; however, conservative therapy was successful. She was subsequently discharged, and 12-month follow-up revealed no further sequelae. Conclusions We describe a rare case of Klebsiella liver abscess syndrome, which first presented with a central nervous system manifestation. Our patient was successfully treated via an early surgical intervention and subsequent antibiotic therapy. Although surgical drainage remains the cornerstone treatment for brain abscess, when a brain abscess is found, and there is a high index of suspicion for the existence of a liver abscess, Klebsiella liver abscess syndrome should be considered as a possible diagnosis.
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Sexton GP, Nae A, Cleere EF, O'Riordan I, O'Neill JP, Lacy PD, Amin M, Colreavy M, Caird J, Crimmins D. Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children. Int J Pediatr Otorhinolaryngol 2022; 156:111093. [PMID: 35272257 DOI: 10.1016/j.ijporl.2022.111093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. METHODS A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. RESULTS 65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. CONCLUSION Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.
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Affiliation(s)
- G P Sexton
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland.
| | - A Nae
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - E F Cleere
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - I O'Riordan
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - J P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - P D Lacy
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - M Amin
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - M Colreavy
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland; University College Dublin School of Medicine, Ireland
| | - J Caird
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
| | - D Crimmins
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
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Borni M, Znazen M, Kolsi F, Zaher Boudawara M. Clinico-radiological assessment and therapeutic management of intracranial suppurations: Bicentric series of 43 cases with literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Depuru A, Shirin Lazar M, Naik NB, Ganesh V, Singh A, Gorla D. Neurosurgical Emergency in an Adult With Single Ventricle Physiology: A Case Report. A A Pract 2022; 16:e01558. [PMID: 35050907 DOI: 10.1213/xaa.0000000000001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The anesthetic management of a patient with uncorrected congenital heart disease presenting for noncardiac surgery is quite challenging. When this becomes a neurosurgical emergency, the need to balance cerebral and complex circulatory physiologies tests the anesthesiologist's preparedness. The principal clinical challenges we faced were preventing increases in intracranial pressure while maintaining the circulatory physiology using the "cardiac grid" approach to hemodynamic management in a case of acyanotic double outlet right ventricle with a posterior fossa space-occupying lesion. Point of care preoperative echocardiography enabled us to understand the altered circulatory physiology and successfully manage this patient.
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Affiliation(s)
- Aparna Depuru
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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44
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Perkins A, Trimmier M, Liu G. Selected Disorders of the Nervous System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Focused Management of Patients With Severe Acute Brain Injury and ARDS. Chest 2022; 161:140-151. [PMID: 34506794 PMCID: PMC8423666 DOI: 10.1016/j.chest.2021.08.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 02/04/2023] Open
Abstract
Considering the COVID-19 pandemic where concomitant occurrence of ARDS and severe acute brain injury (sABI) has increasingly coemerged, we synthesize existing data regarding the simultaneous management of both conditions. Our aim is to provide readers with fundamental principles and concepts for the management of sABI and ARDS, and highlight challenges and conflicts encountered while managing concurrent disease. Up to 40% of patients with sABI can develop ARDS. Although there are trials and guidelines to support the mainstays of treatment for ARDS and sABI independently, guidance on concomitant management is limited. Treatment strategies aimed at managing severe ARDS may at times conflict with the management of sABI. In this narrative review, we discuss the physiological basis and risks involved during simultaneous management of ARDS and sABI, summarize evidence for treatment decisions, and demonstrate these principles using hypothetical case scenarios. Use of invasive or noninvasive monitoring to assess brain and lung physiology may facilitate goal-directed treatment strategies with the potential to improve outcome. Understanding the pathophysiology and key treatment concepts for comanagement of these conditions is critical to optimizing care in this high-acuity patient population.
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46
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Bedi T, Naga R. Temporal lobe abscess – as a result of COVID pandemic. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Holla VV, Prasad S, Pal PK. Neurological effects of respiratory dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:309-329. [PMID: 36031312 DOI: 10.1016/b978-0-323-91532-8.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The respiratory and the nervous systems are closely interconnected and are maintained in a fine balance. Central mechanisms maintain strict control of ventilation due to the high metabolic demands of brain which depends on a continuous supply of oxygenated blood along with glucose. Moreover, brain perfusion is highly sensitive to changes in the partial pressures of carbon dioxide and oxygen in blood, which in turn depend on respiratory function. Ventilatory control is strictly monitored and regulated by the central nervous system through central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and the autonomic nervous system. Disruption in this delicate control of respiratory function can have subtle to devastating neurological effects as a result of ensuing hypoxia or hypercapnia. In addition, pulmonary circulation receives entire cardiac output and this may act as a conduit to transmit infections and also for metastasis of malignancies to brain resulting in neurological dysfunction. Furthermore, many neurological paraneoplastic syndromes can have underlying lung malignancies resulting in respiratory dysfunction. It is essential to understand the underlying mechanisms and the resulting manifestations in order to prevent and effectively manage the many neurological effects of respiratory dysfunction. This chapter explores the various neurological effects of respiratory dysfunction with focus on their pathophysiology, etiologies, clinical features and long-term neurological sequelae.
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Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Hallak B, Bouayed S, Ghika JA, Teiga PS, Alvarez V. Management Strategy of Intracranial Complications of Sinusitis: Our Experience and Review of the Literature. ALLERGY & RHINOLOGY 2022; 13:21526575221125031. [PMID: 36177149 PMCID: PMC9513574 DOI: 10.1177/21526575221125031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Sinusitis or rhinosinusitis is a very common disease worldwide, and in some
cases, it leads to intracranial complications (ICS). These are more common
in immunocompromised patients or with underlying comorbidities, but even
healthy individuals, can be affected. Nowadays, ICS have become less common
thanks to improved antibiotic therapies, radiological diagnostic methods,
surgical techniques and skills. Nonetheless, they can still cause
significant morbidity and mortality. For this reason, management of these
complications requires a multidisciplinary approach to plan and customize
treatment options. This paper presents our strategy in the management of a
series of intracranial complications induced by acute sinusitis and compares
our experience and outcomes with the literature. Study design Single institute experience, retrospective analysis of cases series and
literature review. Methods Adult and child patients who were treated for ICS in the Department of
Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were
included. Their symptoms, medical history, clinical and radiological
findings, treatment, and outcome were documented. Results Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled.
None had any previous history of chronic, or recurrent sinusitis. Moreover,
very few presented specific rhinological symptoms, but with neurological or
other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging
(MRI) were used to confirm the diagnosis of all ICS. All types of known
intracranial complications were observed in our cohort with a wide range of
extension and severity of sinusitis. A multidisciplinary approach with
individual treatments was tailored to each patient. Outcomes were favorable
in almost all patients with neither recurrence, nor neurological sequels
being observed in the follow-up. Only one patient was lost due to fatal
complications of advanced lung cancer. Conclusion ICS remain a challenging clinical problem due to substantial associated
morbidity and mortality. The incidence of these complications is relatively
low. Therapeutical management guidelines are lacking. Early detection and
multidisciplinary approach are key to successful treatment.
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Affiliation(s)
- Bassel Hallak
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
| | - Salim Bouayed
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
| | | | - Pedro S. Teiga
- Department of Otorhinolaryngology, Head and Neck Surgery, Sion Hospital, Sion, Switzerland
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Zafar M, Vaughan S, Khuu B, Shrestha S, Porruvecchio E, Hadid A. Cocaine-Induced Pituitary and Subdural Brain Abscesses and the Treatment Challenges. Cureus 2021; 13:e20821. [PMID: 34987946 PMCID: PMC8717109 DOI: 10.7759/cureus.20821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Cocaine is a well-known recreational drug with stimulant effects associated with relevant social, economic, and clinical implications. The most common route of abuse is via snorting. It has high addictive potential. Furthermore, one of the most well-known symptoms of a chronic user is chronic rhinitis. In the medical journals, there are numerous reports of complications, including lesions affecting the nasal septum, nasal sinuses, and even brain abscesses. We came across a 41-year-old male patient with severe manifestations of chronic cocaine use involving nasal, paranasal, and visual symptoms and signs. However, the most devastating was the complication of pituitary abscess, as a sequela to chronic cocaine sniffing. This case highlights the clinical, diagnostic, and management challenges with a multi-disciplinary approach. Last but not least, was the role of patient counselling and education. This ensured compliance towards management with a favourable outcome, which was rewarding for both the patient and the medical team involved in the care of the patient. It would hopefully create more awareness and assist in abstinence. We also hope it would incite more effort towards data collection and analysis, as well as allow us to explore the actual incidence of its use and devastating complications, which to date, for reasons of disguise and denial, remain somewhat ambiguous.
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50
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Pradhan A, Rutayisire FX, Munyemana P, Karekezi C. Unusual intracranial suppuration: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21570. [PMID: 35855485 PMCID: PMC9281436 DOI: 10.3171/case21570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Although significant progress has been achieved with antibiotics, neuroimaging, and neurosurgical technique, ICS remains a serious neurosurgical emergency. An uncommon presentation of ICS is sterile ICS, which has yet to be fully elucidated by clinicians. The authors present 2 cases of unusual sterile ICS: a sterile subdural empyema and a sterile brain abscess. OBSERVATIONS Both patients underwent surgical treatment consisting of craniotomy to evacuate the pus collection. The blood cultures from both the patients, the collected empyema, and the thick capsule from the brain abscess were sterile. However, the necrotic brain tissue surrounding the abscess contained inflammatory cells. The authors’ review of the literature emphasizes the rarity of sterile ICS and substantiates the necessity for additional studies to explore this field. LESSONS Sterile ICS is a disease entity that warrants further investigation to determine appropriate treatment to improve patient outcomes. This study highlights the paucity of data available regarding sterile ICS and supports the need for future studies to uncover the etiology of sterile ICS to better guide management of this condition.
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Affiliation(s)
- Anjali Pradhan
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, Los Angeles, California; and
| | | | - Paulin Munyemana
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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