Intracranial abscesses: Retrospective analysis of 32 patients and review of literature

Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess

INTRODUCTION

Brain abscesses (BA) form approximately 8% of intracranial masses in developing and 1-2% in western countries. Fungal BA (FBA) are aggressive and represent a catastrophic manifestation compared to protozoan and bacterial BA. Diagnosis of FBA is rare and usually done postmortem.

OBJECTIVES

The present retrospective study analyses the clinico-mycological aspects of FBA presented to our neurosurgical services over a period of 38 years, from January 1979 to April 2017.

MATERIALS AND METHODS

Patients diagnosed as definitive cases of FBA were included in the study. Clinico- demographic and microbiological data were collected from medical records. BA pus was examined for fungal etiology using standard microbiological procedures.

RESULTS

During the period of 38 years out of total 2,916 brain abscesses, 29 cases of FBA were diagnosed with an overall incidence rate of 0.99% per year. Cladophialophora bantiana (44%) was the most predominant isolate followed by Aspergillus spp and others. Male preponderance was seen with a male:female ratio of 4.8:1. There was no predilection for any age group. Headache, limb weakness and fever were the most common presentations. Amphotericin B was given in 44.8% of cases. Craniotomy with excision (48.2%) was the predominant surgical management. Outcome was fatal in 62% of the cases.

CONCLUSION

Neurotropic C. bantiana is the predominant isolate causing fungal brain abscess. The incidence and trends of fungi causing brain abscess do not show significant change. Young immunocompetent outdoor working males were predominantly susceptible to fungal infection. Advance in the diagnostic modalities show promising in diagnosis of FBA. High index of suspicion with early diagnosis, prompt antifungal therapy and aggressive surgical management is required as FBA are associated with high mortality rate.

Novel approach to the treatment of a cerebral abscess using the Apollo vibration/suction device

BACKGROUND AND IMPORTANCE

Intracerebral abscess is a very serious condition associated with significant morbidity and mortality. This article describes a novel treatment for a cerebral abscess, using the Penumbra Apollo suction/vibration aspiration system (Penumbra, Almeda, CA, USA). This article represents the first reported case of the device's use for treatment of an intracerebral abscess.

CLINICAL PRESENTATION

The patient discussed presented to the emergency department in critical condition, and was found to be suffering from a right thalamic cerebral abscess. She underwent treatment with both medical management and surgical intervention with the use of the Apollo system.

CONCLUSION

This report details a novel technique for surgical abscess drainage with an excellent clinical outcome. The aim is to provide insight into the treatment of intracerebral abscesses, the utility of the Apollo system, and the device's application beyond intracerebral and intraventricular hemorrhage.