Endoscopic treatment of brain abscess

Background: Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients. Methods: This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months. Results: There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14–15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation. Conclusion: Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.

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Brain Abscess Caused by Nocardia: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1719124 ◽

2020 ◽

Author(s):

Guilherme Finger ◽

Maria Eduarda Conte Gripa ◽

Tiago Paczko Bozko Cecchini ◽

Tobias Ludwig do Nascimento

Keyword(s):

Case Report ◽

Antibiotic Therapy ◽

Brain Abscess ◽

Clinical Signs ◽

Occipital Lobe ◽

High Morbidity ◽

Rare Clinical Entity ◽

Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

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Otitis Media in Infancy: Tympanometric Findings

PEDIATRICS ◽

10.1542/peds.63.3.435 ◽

1979 ◽

Vol 63 (3) ◽

pp. 435-442

Author(s):

Jessie R. Groothuis ◽

Sarah H. W. Sell ◽

Peter F. Wright ◽

Judith M. Thompson ◽

William A. Altemeier

Keyword(s):

Otitis Media ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Normal Pressure ◽

Pressure Curve ◽

Type B ◽

History Of ◽

Life Type ◽

Insight Into

Ninety-one normal infants were followed longitudinally for varying periods from November 1975 to April 1977 to assess the correlation between tympanometry and pneumatic otoscopy and to study the pathogenesis of acute and chronic otitis media early in life. Type A (normal) tympanograms correlated with normal otoscopic findings in 92% of instances. Type B tympanograms, indicating reduced drum compliance with a relatively flat pressure curve, were associated with abnormal otoscopic findings in 93% of cases. The A8 (reduced compliance, normal pressure) and C (normal compliance, negative pressure) tympanograms were less consistent predictors of otoscopic findings. The correlation of tympanometric and otoscopic findings were similar in infants above and below 7 months of age. Tympanometry provided some insight into the natural history of otitis in 71 infants followed 12 to 17 months. Infants who failed to develop otitis had type B curves in only one of 240 determinations (0.4%). This pattern did not appear in those who developed acute otitis media (AOM) until the month preceding the first attack; nine of 29 tests (31%) made under these circumstances were type B. When a type B curve appeared in an asymptomatic study infant who had not previously had otitis, AOM developed within a month in nine of ten instances. At the time of diagnosis of first AOM, 87% of tympanograms were type B with the remainder type A8 or C. Sixty-three percent of tympanograms obtained from 25 infants during the six months following first AOM were type B, indicating that abnormal middle ear function was often prolonged. Fifteen of these 25 developed recurrent otitis during follow-up.

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Stereotactic Aspiration and Antibiotic Treatment Combined with Hyperbaric Oxygen Therapy in the Management of Bacterial Brain Abscesses

Neurosurgery ◽

10.1227/01.neu.0000186012.95462.e5 ◽

2005 ◽

Vol 57 (6) ◽

pp. 1140-1146 ◽

Cited By ~ 20

Author(s):

Murat Kutlay ◽

Ahmet Çolak ◽

Şenol Yıldız ◽

Nusret Demircan ◽

Osman Niyazi Akın

Keyword(s):

Brain Abscess ◽

Antibiotic Treatment ◽

Hyperbaric Oxygen ◽

Surgical Techniques ◽

Adjunctive Treatment ◽

Stereotactic Aspiration ◽

Systemic Antibiotic Therapy ◽

Number Of Patients ◽

Brain Abscesses

Abstract OBJECTIVE: Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment. METHODS: Between 1999 and 2004, 13 patients with bacterial brain abscesses treated with stereotactic aspiration combined with HBO and systemic antibiotic therapy. Patients younger than 18 years of age were excluded from this study. Postoperatively, all patients were given a 4-week course of intravenous antibiotics. Additionally, patients received hyperbaric oxygen (HBO, 100% O2 at 2.5 ATA for 60 min) twice daily for five consecutive days, and an additional treatment (100% O2 at 2.5 ATA for 60 min daily) was given for 25 days. RESULTS: There were eight male and five female patients. Their ages ranged between 18 and 71 years, with a mean of 43.9 years. The average duration of follow-up was 9.5 months (range, 8–13 mo). This treatment modality allowed infection control and healing for all 13 patients with 0% recurrence rate. HBO treatment was tolerated well, and there were no adverse effects of pressurization. At the end of the follow-up period, 12 patients had a good outcome: nine are without sequelae, and three have a mild hemiparesis but are capable of self-care. One patient has a moderate hemiparesis. CONCLUSION: Although the number of patients is small, this series represents the largest reported group of brain abscess patients treated with stereotactic aspiration combined with antibiotic and HBO therapy. Our preliminary results indicate that the length of time on antibiotics can be shortened with the use of HBO as an adjunctive treatment.

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PROPORTIONS AND CHARACTERISTICS OF PATIENTS WITH BRAIN ABSCESS AT SANGLAH GENERAL HOSPITAL IN DENPASAR, BALI, INDONESIA IN 2019-2020

Romanian Journal of Neurology ◽

10.37897/rjn.2021.2.8 ◽

2021 ◽

Vol 20 (2) ◽

pp. 176-182

Author(s):

Putu Satyakumara Upadhana ◽

◽

Ni Putu Kostarika Melia Daradila ◽

Anak Agung Bagus Putra Indrakusuma ◽

I Gede Krisna Arim Sadeva ◽

...

Keyword(s):

General Hospital ◽

Brain Abscess ◽

Univariate Analysis ◽

Brain Parenchyma ◽

Cross Sectional ◽

Main Complaint ◽

History Of ◽

Brain Abscesses ◽

The Right ◽

High Level

Introduction. A brain abscess is a collection of pus, immune cells, and other materials that are generally caused by bacterial or fungal infection in the brain parenchyma. This disease has a high level of morbidity and mortality, nonetheless, until now there has been no in-depth research on this disease, especially in Bali. Objective. This study aimed to determine the proportion and characteristics of patients with brain abscess at the Sanglah General Hospital, Denpasar, Bali, Indonesia in 2019-2020. Material and methods. This study is an observational study with a cross sectional method. A total of 41 patients with brain abscesses recorded in hospital medical records in 2019-2020 were included in this study. Univariate analysis was performed to obtain the characteristics of patients with brain abscesses. Results. Most of the patients were male (63.4%), aged 20-39 years. The main complaint most often found in patients was decreased consciousness (56.1%), with neurological symptoms in the form of hemiparesis (32.3%). Most of the abscesses were found on the right frontal, right parietal and left parietal with a percentage of 14.06% each. The CT scan results showed a rim contrast enhancement (63.4%), cerebral edema (75.6%), and normal sulcus gyri (51.2%). Up to 50% of patients with a history of surgical procedures underwent a craniotomy. Other disease histories most often found in patients were sinusitis (29.5%), diabetes mellitus (15.3%), and toxoplasmosis (12.5%). Conclusion. There are varying results of the clinical characteristics of patients with brain abscesses, and indicate the natural course of this disease.

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Brain Abscess Associated with Polymicrobial Infection after Intraoral Laceration: A Pediatric Case Report

Case Reports in Pediatrics ◽

10.1155/2020/8304302 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Fumihiro Ochi ◽

Hisamichi Tauchi ◽

Toyohisa Miyata ◽

Tomozo Moritani ◽

Toshiyuki Chisaka ◽

...

Keyword(s):

Brain Abscess ◽

Antimicrobial Therapy ◽

Fusobacterium Nucleatum ◽

Brain Parenchyma ◽

Pediatric Case ◽

Parvimonas Micra ◽

Increased Risk ◽

Brain Abscesses ◽

Congenital Cyanotic Heart Disease ◽

The Brain

Brain abscesses, infections within the brain parenchyma, can arise as complications of various conditions including infections, trauma, and surgery. However, brain abscesses due to polymicrobial organisms have rarely been reported in children. We herein report a case of a 9-year-old girl with unresolved congenital cyanotic heart disease (CCHD) presenting with right hemiplegia who was diagnosed with brain abscess caused by Streptococcus intermedius, Parvimonas micra, and Fusobacterium nucleatum after oropharyngeal injury. She was treated with intravenous antimicrobial therapy, drainage under craniotomy, and antiedema therapy with glycerol and goreisan, which led to the improvement of right hemiplegia to baseline; she was discharged following eight weeks of intravenous antimicrobial therapy. The clinical diagnosis of the brain abscess was difficult due to the nonspecific presentation, highlighting the importance of cranial imaging without haste in patients at increased risk for brain abscesses such as those with CCHD, presenting with fever in the absence of localizing symptoms or fever, accompanied with abnormal neurological findings.

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Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

Case Reports in Veterinary Medicine ◽

10.1155/2015/372608 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9

Author(s):

Amy W. Hodshon ◽

Jill Narak ◽

Linden E. Craig ◽

Andrea Matthews

Keyword(s):

Brain Abscess ◽

Subdural Hematoma ◽

Skull Fracture ◽

Chronic Subdural Hematoma ◽

Complete Removal ◽

Intracranial Mass ◽

Brain Abscesses ◽

The Right ◽

Aerobic And Anaerobic

A 2-year-old female spayed Miniature Dachshund was presented for seizures and right prosencephalic signs. A multiloculated, ring-enhancing mass in the right cerebrum associated with dilation of the right lateral ventricle and brain herniation was seen on magnetic resonance imaging. An irregular calvarial defect with smoothly scalloped edges was seen overlying the mass on computed tomography. The mass was removed via craniectomy and was diagnosed as a chronic brain abscess caused byPeptostreptococcus anaerobius. The patient was maintained on antibiotics for 12 weeks. Follow-up MRI performed 14 weeks after surgery confirmed complete removal of the abscess as well as a contrast-enhancing collection of extra-axial material consistent with a chronic subdural hematoma. The neurologic abnormalities, including seizures, have improved in the 44 months since surgery. Brain abscesses in dogs can have an insidious clinical course prior to causing serious neurologic deterioration. Ventricular entrapment by an intracranial mass can contribute to acute neurologic decline. If surgically accessible, outcome following removal of a brain abscess can be excellent; aerobic and anaerobic bacterial culture should be performed in these cases. Subdural hematoma can occur following removal of a large intracranial mass. Growing skull fractures can occur in dogs but may not require specific surgical considerations.

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Spray cryotherapy prevents need for palliative stenting in patients with esophageal cancer-associated dysphagia

Diseases of the Esophagus ◽

10.1093/dote/doab051 ◽

2021 ◽

Author(s):

Yuri Hanada ◽

Cadman L Leggett ◽

Prasad G Iyer ◽

Bryan Linn ◽

Tiffany Mangels-Dick ◽

...

Keyword(s):

Esophageal Cancer ◽

Primary Outcome ◽

Common Symptom ◽

Limited Data ◽

Related Complication ◽

Complication Risk ◽

Patient Database ◽

History Of ◽

Cancer Palliation

Abstract Background Dysphagia is the most common symptom in advanced esophageal cancer patients. Esophageal stent placement (SP) is a common palliation method but can be associated with significant morbidity. Limited data exist regarding the ability of spray cryotherapy (SC) prolong time to SP. Methods A Mayo Clinic (Rochester, MN) patient database was reviewed for cases with a SC indication of esophageal cancer palliation from 2007–2019. Procedures were performed using a liquid nitrogen SC system to apply 2–5 separate 20 second freeze and 60 second thaw cycles based on tumor characteristics. Primary outcome was time to subsequent palliative SP. Results Of 56 patients (71.4% male, mean age 77.8 ± 10.2 years) who underwent a total of 199 SC sessions (mean 3.6 ± 2.7, range 1–12 per patient), 41 had adenocarcinoma and 15 squamous cell carcinoma (SCC). Overall, 13 patients underwent subsequent SP within a mean duration of 15.7 ± 11.0 months over a mean follow-up duration of 25.6 ± 29.4 months. Treatment did produce stenosis in 16 patients, who required dilation within a mean period of 193.1 ± 294.1 days; notably, 10 patients had a history of preceding malignant strictures requiring dilation. Two patients experienced bleeding requiring transfusion, whereas 1 experienced perforation at the start of SC. Prior chemotherapy and/or radiation was not associated with developing an SC-related complication (risk ratio (RR) 1.5; 95% CI 0.6–3.7, P > 0.4). Conclusions SC appears to be an effective and safe modality to palliate esophageal cancer in appropriate candidates. Majority of patients who undergo SC avoid the need for future SP. If patients eventually require SP, they are able to, on average, defer stenting for >1 year from SC initiation.

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Listeria monocytogenes Brain Abscess Mimicking Ischemic Stroke in an Immunocompromised Patient: A Case Report

Clinical Management Issues ◽

10.7175/cmi.v13i1.1420 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Angeliki Tsifi ◽

Stavroula Panagiota Lontou ◽

Maria Triantafyllou ◽

Sevastianos Chatzidavid ◽

Dimitrios Theodoridis ◽

...

Keyword(s):

Listeria Monocytogenes ◽

Brain Abscess ◽

Corticosteroid Treatment ◽

Antimicrobial Treatment ◽

Oral Amoxicillin ◽

Brain Abscesses ◽

Recent Diagnosis ◽

Magnetic Resonance Imaging Mri ◽

Mri Study

Listeria monocytogenes (L. monocytogenes) is a Gram-positive bacillus that infects immunocompromised persons, neonates, pregnant women and, occasionally, previously healthy individuals. L. monocytogenes brain abscesses are particularly rare.We present a 62-year-old female on corticosteroid treatment due to a recent diagnosis of autoimmune hepatitis, who suddenly developed right hemiparesis mimicking a stroke. A brain computerized tomography (CT) scan revealed a brain abscess and the blood cultures drawn yielded L. monocytogenes. A conservative treatment without surgical intervention was selected. The patient was commenced on intravenous ampicillin and gentamicin and showed remarkable improvement. She was successfully discharged on oral amoxicillin with probenecid. Since the subsequent magnetic resonance imaging (MRI) study and CT scans exhibited reduction in the size of the abscess, the antimicrobial treatment was discontinued after a three-month period. The patient underwent regular follow-up visits with no signs of relapse.

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Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

Access Microbiology ◽

10.1099/acmi.0.000270 ◽

2021 ◽

Vol 3 (10) ◽

Author(s):

Brendan Ryu ◽

Deepak Khatri ◽

Avraham Zlochower ◽

Stephen Maslak ◽

Randy S. D’Amico

Keyword(s):

Brain Abscess ◽

Clinical Symptoms ◽

Sella Turcica ◽

Csf Leak ◽

Case Presentation ◽

Brain Abscesses ◽

Pituitary Enlargement ◽

Operative Recovery ◽

Sellar Floor

Introduction. Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature. Case Presentation. We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up. Conclusion. Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.

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