Management of brain abscess: an overview

✓ Recent advances in neuroimaging have resulted in a marked decrease in morbidity and death due to brain abscesses. The advent of computed tomography–guided stereotaxy has reduced morbidity in patients with deep-seated abscesses. Empirical therapy is best avoided in the present era, particularly given the availability of stereotactic techniques for aspiration and confirmation of diagnosis. Despite these advances, management of abscesses in patients with cyanotic heart disease and in immunosuppressed patients remains a formidable challenge. Unusual as well as more recently recognized pathogens are being isolated from abscesses in immunosuppressed patients. The authors provide an overview of the management of brain abscesses, highlighting their experience in managing these lesions in patients with cyanotic heart disease, stereotactic management of brain abscesses, and management of abscesses in immunosuppressed patients.

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Brain abscess in association with cyanotic heart disease

The Indian Journal of Pediatrics ◽

10.1007/bf02751185 ◽

1960 ◽

Vol 27 (12) ◽

pp. 429-434 ◽

Cited By ~ 1

Author(s):

B. N. S. Walia ◽

P. O. Ghai ◽

P. N. Taneja ◽

Atm Prakash ◽

K. Deshpande

Keyword(s):

Heart Disease ◽

Brain Abscess ◽

Cyanotic Heart Disease

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Current Treatment of Brain Abscess in Patients with Congenital Cyanotic Heart Disease

Neurosurgery ◽

10.1097/00006123-199712000-00006 ◽

1997 ◽

Vol 41 (6) ◽

pp. 1270-1278 ◽

Cited By ~ 50

Author(s):

Mikihiko Takeshita ◽

Mizuo Kagawa ◽

Seiji Yato ◽

Masahiro Izawa ◽

Hideaki Onda ◽

...

Keyword(s):

Heart Disease ◽

Brain Abscess ◽

Current Treatment ◽

Cyanotic Heart Disease ◽

Congenital Cyanotic Heart Disease

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Management of brain abscess in patients with congenital cyanotic heart disease

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(97)81358-3 ◽

1997 ◽

Vol 99 ◽

pp. S26

Author(s):

M. Takeshita ◽

M. Kagawa ◽

S. Yato ◽

M. Izawa ◽

H. Onda ◽

...

Keyword(s):

Heart Disease ◽

Brain Abscess ◽

Cyanotic Heart Disease ◽

Congenital Cyanotic Heart Disease

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Potential Nosocomial Acquisition of EpidemicListeria monocytogenesPresenting as Multiple Brain Abscesses Resembling Nocardiosis

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2010/812648 ◽

2010 ◽

Vol 21 (1) ◽

pp. 57-60 ◽

Cited By ~ 3

Author(s):

Aleksandra Stefanovic ◽

James Reid ◽

A Celine Nadon ◽

Jennifer Grant

Keyword(s):

Listeria Monocytogenes ◽

Brain Abscess ◽

Antimicrobial Therapy ◽

Hematological Malignancies ◽

Solid Organ ◽

Gram Stain ◽

Current Case ◽

Cerebellar Abscess ◽

Immunosuppressed Patients ◽

Brain Abscesses

Listerial brain abscesses are rare, and are found mostly in patients with underlying hematological malignancies or solid-organ transplants. A case of a patient with Crohn’s disease and multiple brain abscesses involving the left cerebellum and right sylvian fissure is described. The Gram stain and histopathology of the cerebellar abscess revealed Gram-positive, beaded rods suggestive ofNocardia. However, on culture,Listeria monocytogeneswas identified.Listeriamay appear Gram-variable and has been misidentified as streptococci, enterococci and diphtheroids. The present case is the first reported case ofL monocytogenesresemblingNocardiaon both microbiological and histopathological assessment. Reported cases of listerial brain abscesses are sporadic, while the current case was part of a nationwide listerial outbreak linked to consumption of contaminated deli meats. Broad antimicrobial therapy (including antilisterial coverage) in immunosuppressed patients presenting with brain abscess is crucial, until cultures confirm the identification of the organism.

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Ipsilateral Progressive Hydrocephalus Due to Acquired Foramen of Monro Obstruction: An Unusual Complication of Brain Abscess in Cyanotic Heart Disease

Neurosurgery ◽

10.1227/00006123-198801000-00030 ◽

1988 ◽

Vol 22 (1) ◽

pp. 154-156

Author(s):

Arun K. Gupta ◽

Rajeev Sharma

Keyword(s):

Heart Disease ◽

Brain Abscess ◽

Unusual Complication ◽

Cyanotic Heart Disease ◽

Foramen Of Monro

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Klebsiella brain abscess in an immunocompetent patient: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02633-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Clay Wu ◽

Semi Han ◽

Ahmet Baydur ◽

Brett Lindgren

Keyword(s):

Computed Tomography ◽

Klebsiella Pneumoniae ◽

Brain Abscess ◽

Mental Status ◽

Klebsiella Oxytoca ◽

Brain Magnetic Resonance Imaging ◽

Altered Mental Status ◽

Immunocompetent Patient ◽

Normal Limits ◽

Brain Abscesses

Abstract Background Klebsiella pneumoniae brain abscesses are a rare entity and typically present in immunocompromised patients. We present a case of an overall healthy patient who developed a Klebsiella pneumoniae brain abscess in the absence of liver pathology. Case presentation A 46-year-old Vietnamese man with past medical history significant for hypertension presented to the hospital with acute on chronic worsening of altered mental status, personality changes, and gait dysfunction. Initial vitals revealed temperature of 37.1 °C, heart rate 87 beats/minute, blood pressure 150/87 mmHg, respiratory rate 18/minute, and oxygen saturation 99% on room air. Physical exam was notable for altered mental status, Glasgow Coma Scale (GCS) score of 14, and right lower facial droop. Cardiopulmonary exam was within normal limits. Head computed tomography (CT) showed a left frontotemporal mass, with subsequent brain magnetic resonance imaging (MRI) revealing a ring-enhancing lesion concerning for a brain abscess. The abscess was urgently drained; however, there was intraoperative spillage into the ventricles. Intraoperative cultures grew Klebsiella pneumoniae, and the patient was maintained on appropriate antibiotics. He developed worsening mental status, septic shock, and cerebral edema requiring decompressive left hemicraniectomy. Computed tomography of the abdomen and pelvis revealed no hepatic lesions. The patient did not improve, and the family elected for comfort measures. Conclusion High mortality is associated with Klebsiella pneumoniae (as opposed to Klebsiella oxytoca) brain abscesses, especially in the setting of intraventricular spread. This case illustrates the need for early detection, and an aggressive medical and surgical treatment approach is required for a potential favorable outcome.

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