Four cases of brain abscess in neonates are described, diagnosed by ultrasonography and CT. All abscesses were confirmed surgically. One patient was operated on 5 weeks after diagnosis because of initial parental refusal. The etiology in all cases was meningitis superimposed on an hypoxic-ischemic insult. Two cases had a single abscess while the other two had multiple lesions. All cases were operated on with intraoperative ultrasound examination through the fontanelle. The case with delayed aspiration showed complete evolution from localized cerebritis to complete capsule formation with mass effect. One abscess was sterile, and in the others grew Klebsiella pneumoniae and Enterobacter aerogenes. The microorganism initially isolated from the lumbar CSF was also found in the abscess. Even after sterilization of the lumbar CSF, all abscesses were still present. Ultrasound examination and CT are compared.
The author review 10 years' experience in managing brain abscess in childhood: 19 cases were treated in children from 1 to 18 years old. The etiology was rhinogenic in 5 cases, congenital heart disease in 5, hematogenous in 3, traumatic in 3, postoperative in 1, and unknown in 3 cases. Brain abscesses that developed by direct spread were located nearby the source, whereas metastatic abscesses (such as cardiogenic or hematogenous) in most cases spread via the vertebral-basilar system, usually developing in the parieto-occipital regions. Four of the 5 cases with multiple abscesses were cardiogenic and one hematogenous. The most important neurological signs were paresis (10 cases) and cranial nerve involvement (10 cases). Six abscesses were sterile and 6 grew aerobic and 6 anaerobic bacteria. In one case, aerobic as well as anaerobic bacteria were found. Fifteen patients were treated preoperatively with antibiotics. The treatment was operative in 17 cases. In two cases, gravely ill on admission, no surgical treatment was given. The etiology, localization, bacteriology, surgical methods, and results in those cases are discussed.
The first signs of Sylvian Depression in embryogenesis may be detected at the end of the second intrauterine month and become more apparent as a Sylvian groove at the end of the third month. The temporal operculum grows more effectively in the anterior two thirds and reaches the Sylvian fissure in the fourth month. At the same time the fronto-parietal operculum becomes evident and gradually extends backwards to meet the anterior part of the temporal operculum. These changes occur in the later half of the fifth month. Because the growth of the temporal operculum is more intense than that of the fronto parietal one, it follows that, when the opercula meet in the sixth intrauterine month, there is more of the Sylvian area covered by the temporal than by the fronto-parietal operculum. (Fig. 1) The present syndrome (Agenesis of the perisylvian region) is considered to be a disturbance of this cerebral embryogenesis and becomes evident during the last three months of foetal life. Arachnoid cysts are to be found in the hypoplastic region, sometimes with space occupying character. 70 cases of agenesis of the fronto-temporal area with diagnosis was mostly made during operation. The patients were operated under the tentative diagnosis of a space occupying lesion like subdural haematoma, external hydrocephalus, porencephaly, intracerebral haematoma or tumor.Before the syndrome of agenesis of the perisylvian region had been com pletely understood, the following synonyms had been used: cystic pseudotumor cerebri, meningitis serosa circumscripta, relapsing juvenile subdural haematoma, subarachnoid pouch, cerebral arachnoid cyst, chronic subarachnoid cyst and temporal lobe agenesis syndrome.The outward appearance of the patients is characterized by face and skull asymmetries with depression or elevation of the eyebrow; sometimes other
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