Successful Prognosis of Brain Abscess during Pregnancy.
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Abstract:
Brain abscess in pregnancy is very rare, which mostly progresses to neurological abnormalities.The patient is a 24-year-old pregnant woman. She was referred to Saitama hospital due to severe headache and nausea on October 2008. Brain MRI detected a 1.5 cm abscess mass with extensive edema in the right frontal lobe. We performed intensive therapy using some antibiotics that included cefotaxime and meropenem and depressants for intracranial pressure for six weeks. There was a good prognosis for the woman and her fetus without any sign of neurological abnormalities.Early medical intervention is required before it is too late for brain abscess in pregnancy.Keywords:
Brain abscess
Presentation (obstetrics)
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Introduction
Brain abscess is a rare but life-threatening condition in children which may result from contiguous site infection, haematogenous seeding, penetrating traumatic injury, neurosurgical procedure or cryptogenic source.Clinical case
A twelve-year-old girl presented to the emergency department with severe, progressive left-sided frontal headache of 3 weeks' duration associated with increased somnolence of three days' duration and one episode of vomiting. These symptoms were associated with a left sided periorbital cellulitis, five days after the onset of headache, which was treated in the community with two weeks of oral flucloxacillin and had resolved at the time of presentation. This child's medical history was unremarkable. Neurological examination including gait assessment and fundoscopy were normal. Emergent imaging (CT and MRI) revealed a thick-walled, rim enhancing lesion in the left anterior inferior frontal lobe with associated oedema and mass effect. Left ethmoid and frontal sinusitis were also apparent on MRI. The patient underwent transfer to a neurosurgical facility for emergency burr hole aspiration of left frontal lobe abscess and subsequent naso-endoscopy and sinus decongestion. Streptococcus intermedius was isolated from microbiological samples. She completed five weeks IV antimicrobial therapy followed by three weeks high dose oral therapy. Follow-up imaging revealed a small residual area of enhancement without evidence of persistent abscess. Clinically she remains well without sequelae.Conclusions
The presentation of brain abscess is diverse with headache (70%), nausea and vomiting (50%), fever (40%), seizures (25%), focal neurological signs (50%), and nuchal rigidity (25%). Only 10% of children with a brain abscess will have an absent underlying medical condition that increases their risk of brain abscess. 15% will have a preceding Frontal sinusitis and only 2.5% a preceding Ethmoid sinusitis. In children with chronic progressive headaches sinister aetiologies must be excluded and appropriate neurological imaging performed.Frontal sinus
Brain abscess
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Case Report 10 days before admission a 45-year old female experienced general weakness, and T 38oC. During that period she had no cardio-respiratory nor neurological complaints, and the temperature varied between 37.5oC and 38oC. Her medical history was unremarkable, without immunodeficiency. The day before admission she presented with left arm paresis and during the next day it progressed to paralysis. She had no headache. On admission the following diagnostic procedures were performed: the cranial CT scan showed two lesions (possibly meta lesions). Chest X-ray was normal. WBC=15x109/L, ESR= 90/120. On the second day following admission brain MRI showed multiple abscesses in both hemispheres, mostly in the gray/white junction. High doses of IV metronidasol, cephtriaxon and cipfloxacin were administered without obtaining specimens for micro- biological diagnosis. In next two days she developed coma, respiratory insufficiency and septic temperature. Brain surgery was not performed due to severe involvement of the brain with multiple abscesses. Repeated chest X-ray revealed bilateral pneumonia. A lethal outcome occurred on the third day, regardless of all efforts. Autopsy showed multiple brain abscesses as well as on the lungs and liver. A beta-hemolytic streptococcal infection was established. Conclusions Prevention includes treatment of the infection source. The classic triad of headache, fever and focal deficit occur in less than 50% of patients. Even in such cases brain abscess must be reconsidered. CT appearance of brain abscess is similar to that of neoplastic and other infectious and non infectious deseases - especially in the stage of early cerebritis. If the CT findings are not clear, MRI should be performed.
Brain abscess
Paresis
Coma (optics)
Aspiration Pneumonia
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Brain abscesses are a rare form of neurologic infection that can be attributed to a primary source of infection 60–70% of the time. Cases that cannot be attributed to a primary source of infection are rare and are deemed cryptogenic. Brain abscesses are more commonly seen in the frontal & temporal lobes contiguous with primary infections. Parietal and occipital lobe abscesses are uncommon locations. Diagnosis is typically made through advanced imaging, CT scan or MRI. Treatment involves neurosurgical drainage and intravenous antibiotics. Prognosis of an abscess depends on myriad factors but residual neurologic deficits or development of epilepsy can be seen. Death can occur if an abscess ruptures or the abscess is complicated by the patient's underlying chronic health problems. A 24 year old, previously healthy and immunocompetent woman presented to the emergency department with complaints of new headache and suspected seizure at home. She subsequently had two witnessed seizures in the ER and underwent CT of the head which showed a parieto-occipital mass, suspected to be a neoplasm. MRI findings were consistent with CT, abscess was less likely. She underwent biopsy which revealed a brain abscess with Streptococcus intermedius. No primary source of infection or risk factor other than marijuana use was identified. During regular screening her abscess increased in size and she subsequently underwent further drainage and intravenous antibiotic therapy. Advanced imaging has helped to diagnose brain abscesses in patients who present with new neurologic complaints. While brain abscesses are rare they should remain on a clinician's differential in a patient with new neurologic symptoms, particularly if they have risk of developing an abscess such as immunodeficiency, recent neurologic procedure, or cranial trauma. Clinicians must be aware that an abscess can occur without risk factors being present such as this case.
Brain abscess
Streptococcus intermedius
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Brain abscess
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Brainstem abscess is a rare condition with a variety of treatment approaches. In this paper, we report an unusual case of a brainstem abscess with a positive outcome in an immunocompetent patient who was treated with antibiotic therapy.A 22-year-old female presented with bilateral tetraparesis that was worse on the left hemibody, appendicular tremor, and left upper eyelid ptosis. Brain magnetic resonance imaging showed an abscess in the pons and midbrain due to possible nocardiosis. She was treated with dexamethasone, phenytoin, vancomycin, and meropenem for 8 weeks and trimethoprim-sulfamethoxazole for 6 weeks. The brain injury decreased, and the patient's neurological status significantly improved.Brainstem abscess may be treated conservatively, leading to improvement of the clinical condition and decreased lesion size on imaging.
Brain abscess
Pons
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✓ Long-term neurological sequelae were analyzed in 40 patients (24 adults and 16 children) who survived a brain abscess with surgery. Median follow-up was 6 years. The brain abscesses were secondary to hematogenous spread, sinus and mastoid infections, and trauma. Hemiparesis, seizures, visual defects, and learning problems (in children) were the most common sequelae observed. Abscess location played a significant role in determining sequelae. Only two of 16 patients with frontal polar and temporal lobe abscesses had unsatisfactory long-term results, while eight of 16 individuals with abscesses near the sensorimotor strip were left with permanent unsatisfactory neurological sequelae. Nineteen of 24 adults (80%) had a satisfactory long-term neurological status, but only 10 of 16 children (63%) had a similar outcome. In adult survivors, hemiparesis and seizures were mild, and emotional changes rare. Children were often severely paretic, had poorly controlled seizures, suffered from personality impairment, and were occasionally totally disabled. If the postoperative neurological condition is used to evaluate various types of surgical therapy for the treatment of brain abscess, then the therapies under study must be matched for patient age and abscess location before treatment comparisons can be made.
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Hemiparesis
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Cerebral abscess is a potentially fatal neurosurgical condition, despite improvements in technology, new antimicrobial agents and modern neurosurgical instruments and techniques. I report the case of a 64-year-old woman, affected by a right frontobasal brain abscess, compressing the homolateral frontal horn of lateral ventricle, with a second mass partially occupying the right orbital cavity. She presented also with inflammatory sinusopathy involving the right maxillary, ethmoid and frontal sinuses. After 14 d of clinical observation and antimicrobial therapy, the patient received a computed tomography scan, which showed growth of the cerebral mass, with a ring of peripheral contrast enhancement and surrounding edema. She promptly underwent neurosurgical treatment and recovered well, except for the sight in her right eye, which remained compromised, as before the operation. This is believed to be the first case of cryptogenic cerebral abscess caused by Raoultella ornithinolityca isolated from the brain, with more than 1-year follow-up.
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High Grade Astrocytoma (HGAs) is a type of Glioma tumor, observed in less than 15% of all primary neoplasms in the central nervous system, and brain abscess is a relatively rare infection of the parenchyma area. This report is based on HGA cases resembling brain abcesses in girls with symptoms of progressive severe headache accompanied with hemiplegia. An 11-year-old girl was admitted with symptoms of headaches experienced over a period of 4 months. The pain was more progressive, and the patient also has left hemiplegia. Furthermore, head CT scan results with contrast and brain MRI showed a brain abscess (space-occupying lesions – SOL), and tumor removal surgery was performed. The HGA results of Anatomy Pathology were obtained, and therapy was continued with the administration of the HIT-GBM-C protocol. Therefore, a follow-up was performed at 3, 6, 12, and 24 months, and no signs of recurrence were observed. Also, on the outcome of physical examination and brain MRI was within the normal limit. This report shows a rare case of HGA evaluated to share similarities with the incidence of cerebral abscess in children. The tumor diagnosis is based on clinical, radiological and histological examination, principally handled through multi-modality therapy.
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Brain tumor
Neurological examination
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A 40-year-old man had experienced headaches for 6 days and a 51-year-old man (2 weeks after an operation for perianal abscess) had experienced tingling sensations in the left hand for 10 days. After an epileptic seizure both underwent a CT scan of the brain. On these an abnormality was visible, probably a malignant astrocytoma. After several days of complaint reduction with dexamethasone, drowsiness and leftsided hemiparesis occurred. Emergency operations revealed a brain abscess. In the younger patient drainage and the administration of antibiotics were followed by fatal brain oedema. In the eldest drainage and the administration of antibiotics were followed by the extraction of infected teeth; he recovered with a slight loss of strength in the left hand. Brain abscesses are rare in the Netherlands. The diagnosis can be difficult because clinical signs and symptoms are not specific and because an underlying systemic infection is often not apparent. Diffusion-weighted magnetic resonance imaging can nowadays differentiate purulent brain processes from cystic brain tumors. Early treatment (burr hole aspiration and antibiotics) is usually curative. Nevertheless, mortality continues to be almost 10% and (permanent) morbidity 45%.
Brain abscess
Midline shift
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An analysis of 23 consecutive cases of brain abscess is reported. The most frequent early symptoms and signs were headache, vomiting, papiledema, focal neurological abnormalities and pyrexia. Roentgenogram of skull, electroencephahologram and ecoencephalogram were abnormal in all cases in which they were obtained. Therapy was based on early diagnosis with accurate location, aspiration or excision of the abscess. Lumbar puncture is hazardous and yields only suggestive information.
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