We present a case of a 30-year-old male patient who was admitted to our institution with a 4-month history of persistent headache, pain in the left half of the face and the left ear. The initial magnetic resonance imaging detected an inflammatory process in the left pyramid interpreted as petrous apicitis. Subsequently, he developed generalized seizures. Follow-up computed tomography scanning with contrast enhancement demonstrated newly-formed brain abscess in the basal region of the left temporal lobe. The patient underwent microsurgical evacuation and resection of the abscess. Microbiological examination isolated Paenibacillus lactis as a causative microorganism. During the postoperative period, the patient further developed life-threatening meningitis that was successfully managed with prolonged intravenous antimicrobial treatment. Six-months follow-up examination confirmed complete neurological recovery with no signs of recurrence based on Magnetic Resonance Imaging (MRI). To the best of our knowledge, this is the first reported case of brain abscess caused by Paenibacillus lactis in the medical literature.
Introduction: There is substantial literature data dedicated to intracranial epidural hematomas affecting young and middle-aged individuals, but studies focusing on their characteristics in elderly patients are scarce, assuming that old age is a poor prognostic factor.
Aim: The aim of the current study was to review the typical features of the etiology, clinical presentation, disease course, and outcome in a series of cases with epidural hematomas in elderly patients.
Materials and methods: The etiology, clinical presentation, neuroimaging findings, treatment, and outcome in elderly patients operated for traumatic epidural hematomas were investigated in the Clinic of Neurosurgery at St George University Hospital, Plovdiv between January 2015 and December 2020.
The study included patients with isolated traumatic epidural hematoma, as well as those with epidural hematoma in combination with other traumatic intracranial lesions (cerebral contusion, subarachnoid hemorrhage, subdural and intracerebral hematoma). Postoperative epidural hematomas were not included in the study.
The neurological status of patients at admission was assessed using the Glasgow Coma Scale. The Glasgow Outcome Scale was used to monitor their condition during the first month after discharge.
Results: 121 patients with epidural hematomas underwent surgery during the study period in the Clinic of Neurosurgery at St George University Hospital, Plovdiv. Of these patients, 13 (10.7%) were people aged over 65 years (8 women and 5 men, mean age - 69 years). The most common cause of injury was a fall. Twelve patients (92.3%) had associated craniocerebral lesions and only one had an isolated epidural hematoma. Upon admission, 6 patients (46.2%) were neurologically intact. Ten patients were treated surgically, two – conservatively. Good outcome (GOS=4–5) was achieved in 8 patients (61.5%), poor outcome – in one patient, and four patients (30.8%) died.
Conclusions: Good outcome in elderly patients with epidural hematoma can be achieved in two-thirds of the cases, despite the negative influence of the age as a prognostic factor.
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