Brain abscess in childhood-long-term experiences

Abstract

A retrospective evaluation was performed on 28 cases of paediatric brain abscess (male: female ratio 2.5:1; mean age 9.4 years; range 2.8-16 years) diagnosed between 1967 and 1987. In 46%, congenital cyanotic heart disease was identified as a predisposing factor, likewise sinusitis, otitis media or mastoiditis in 29% and immunodeficiency in 11%. Pathogenesis remained unclear in 14%. Initial symptoms and signs were predominantly nonspecific; loss of consciousness occurred in 32% of cases, neurological deficit and seizures each in 25%. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8.4 to 3.0 days, and mortality from 23% to 0%. Seventeen patients (61%) had follow up examinations 9.6 years (mean) after the acute illness (range 1-21 years). Neurological sequelae were diagnosed in 35% of cases, epilepsy in 29%, epileptic potentials during EEG in 12%, and CNS scars in 50%. Psychological testing revealed no statistically significant differences compared to normal populations. CNS scars, and epilepsy and/or epileptic potentials were more common after excision (7 patients) when compared to patients treated by aspiration and/or antibiotics alone (21 patients). It is concluded that excision of brain abscess should be avoided whenever possible. Therapy of choice consists of the administration of adequate antibiotics with or without CT-guided needle aspirations.

Cyanotic complex congenital heart disease presenting with brain abscess at the age of 19: A case report and review of literature

“…It is necessary to mention that cyanotic heart disease accounts for up to 69.1% of all cases of brain abscesses associated with higher incidence in children and peak incidence in between 4 to 7 years of age 1,6 . Most series revealed 1.5 to 2.5 times a male preponderance over female in general population 7,8 . This 19-year-old male having no significant history related to complex congenital cyanotic heart disease presented to us with brain abscess.…”

Mastoiditis, Brain Abscess and Sinus Thrombosis As Complications of Chronic Otitis Media: A Case Report

“…Several studies have reported that the growth ratio of anaerobic bacteria is nearly 25-30% in the case of brain abscess, and Bacteroides and Prevotella species were the most frequently isolated bacteria (10,11). The cases in which anaerobic bacteria are accounted for the development of brain abscess generally occur after middle ear and mastoid infection (12,13). In a study by Menon et al, 75 brain abscess cases were reviewed in a 5-year period, and it was determined that chronic otitis media is the most frequent risk factor.…”

Management of brain abscess: an overview

“…1,2,8,36,42,49,54,60 Empirical medical therapy is best avoided and should be reserved for patients in whom a bacteriological diagnosis has been obtained from a systemic source or who are extremely ill; that is, too ill to undergo any form of intervention. 2,40,51 Small abscesses and lesions in the cerebritis stage respond well to medical therapy alone.…”

“…3,4,8,14,20,22,29,37,39,49,57 Cyanotic heart disease accounts for 12.8-69.4% of all cases of brain abscesses with identified risk factors in several series, with the incidence being higher in children. 1,3,24,39,49 In most series of patients from developed countries, cyanotic heart disease is the most commonly identified risk factor for development of brain abscess in immunocompetent patients. The incidence of brain abscess in patients with cyanotic heart disease has been reported to range between 5 and 18.7%.…”

“…The treatment of choice in these patients is thus aspiration of the abscess through a bur hole or twist-drill craniostomy performed after induction of local anesthesia. 1,22,49,57 Any coagulopathy, if present, should be corrected before the surgical intervention. In one series, the mortality rate following craniotomy and excision was as high as 71%.…”