Surgical strategy for tuberculous brain abscess with dural infiltration: A case report

Background: Tuberculosis is one of the top 10 leading causes of death worldwide. Although tuberculous central complications account for 1% of all tuberculosis patients, there are many cases of medical resistance; and early surgical treatment is required for brain abscess. Reports on tuberculous brain abscesses with dural infiltration are rare, and there are no reports on surgical treatment methods. Case Description: An 81-year-old man was presented with the right arm paresis. His recent medical history included a 6-month course of immunosuppressants, and steroids prescribed for ulcerative colitis, and four antituberculosis drugs had been started 2 months before for relapse of pulmonary tuberculosis at an early age. Head T1-weighted magnetic resonance imaging with administration of gadolinium showed two ring-enhanced lesions in the left precentral gyrus and continuous with the dura mater. Surgery was performed and he was pathologically diagnosed with a tuberculous brain abscess. Since the pathological diagnosis revealed dura mater invasion, we removed the dura mater and reconstructed by periosteum. After the surgery, the symptoms gradually improved, and the abscess and edema improved when viewed on the image. Despite the administration of steroids for ulcerative colitis without antituberculosis drugs, no recurrence was observed for 1 year. Recurrence of tuberculous brain abscess is a major problem in immunosuppressed patients, but it is considered that the relapse could be prevented by removing the dural infiltration. Conclusion: In cases of tuberculous brain abscess with dural infiltration, it is considered that the recurrence can be prevented even in an immunosuppressed state by removing the dura.

Brain Abscess: A Rare Clinical Case with Oral Etiology

Brain abscess is a very rare condition but has a significant mortality rate. The three main routes of inoculation are trauma, contiguous focus, and the hematogenous route. The odontogenic focus is infrequent and is usually a diagnosis of exclusion. This paper presents a brain abscess case proven to be of dental origin, caused by Actinomyces meyeri and Fusobacterium nucleatum. This case highlights the risk underlying untreated dental disease and why oral infectious foci removal and good oral health are essential in primary care.

Brain Abscess of Dental Origin: A Case Report and Literature Review

Introduction: Brain abscess (BA)of dental origin is a rare but potentially life-threatening complication of odontogenic infection that requires immediate neurosurgical attention. It is defined as an encapsulated collection of pus in various areas of the brain. The infectious process spreads from the dental site and occurs in 2 ways: haematogenous route or by contiguity. Treatment should ideally be based on the etiological factor excision, combined with drainage and adjuvant antibiotic therapy. The aim of this article was to report a case of frontal brain abscess of dental origin and to review the literature. Case report: We present the case of a 36-year-old man diagnosed with a brain abscess located in the frontal lobe and caused by a periodontal lesion of the right upper first molar. The final diagnosis was established due to the availability of computed tomography and magnetic resonance imaging. Drainage of the pus combined with extraction of the tooth and antibiotic therapy was followed by an excellent recovery. Clinical and radiological features, treatment and follow-up data were documented. A review of the literature using the PubMed database was performed Conclusion: Oral infections can lead to life-threatening infections, such as brain abscesses. Early detection of this condition through correct diagnosis is essential to give the patient the best treatment; in addition, improving of the oral environment and treating oral infections is highly recommended to limit this serious condition.

Anesthetic Management in Patient with Suspected Brain Abscess, Atrium Septal Defect, and Eisenmenger Syndrome

Introduction: Patients with congenital heart disease especially with systemic shunting between systemic and pulmonary circulation often develop pulmonary hypertension and left-to-right shunt (Eisenmenger syndrome) if left untreated. These patients are at risk of developing spontaneous brain abscess due to brain infarction caused by polycythemia, impaired immune function, and loss of lung phagocytosis. Such patients were often admitted to the emergency room with signs of increased intracranial pressure (ICP), and needed specific consideration during surgery. Case: a 31-year old female diagnosed with intracranial space occupying lesion (SOL) due to suspected brain abscess with concurrent heart defects (atrial septal defect / ASD and Eisenmenger syndrome) was consulted to the operating theatre for emergency burrhole aspiration. The surgery was performed for an hour and the postoperatively the patient was admitted to the intensive care unit (ICU). Conclusion: perioperative management of patients with brain abscess and concurrent ASD and Eisenmenger syndrome consists of preoperative management, methods of anesthesia, monitoring, and interventions to prevent the worsening of left-to-right shunt and increasing intracranial pressure. These managements consist of optimal pain management, perioperative oxygen therapy, and prevention of precipitating factor that increases left-to-right shunting.