Gas-producing Brain Abscess due to Peptostreptococcus

Odake, Genya

doi:10.2176/nmc.24.46

Cited by 9 publications

(1 citation statement)

References 28 publications

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“…Gas‐containing brain abscess is very rare and has been reported to result from bacterial fermentation or escape of air into the cranium through an abnormal communication between the exterior and the cranium [1]. The reported causative pathogens of gas‐containing brain abscess include Clostridium perfringens , Klebsiella pneumoniae , Peptostreptococcus species, and Fusobacterium nucleatum [2–6]. The management of gas‐containing brain abscess is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Gas‐containing brain abscess: Etiology, clinical characteristics, and outcome

Lan

Lee

et al. 2014

The Kaohsiung J of Med Scie

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Gas-containing brain abscess remains a life-threatening disease that requires immediate diagnostic and therapeutic intervention. The aim of this study is to report on a series of gas-containing brain abscess and discuss its pathological mechanism and therapeutic consideration. This study included 11 patients with gas-containing brain abscess at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan during a 27-year period. The predisposing factors to infection included hematogenous spread in five patients, contiguous infection in one patient, and abnormal fistulous communication due to head injury in four patients. In one patient, the predisposing factor might be contiguous infection from frontal sinusitis or abnormal fistulous communication due to previous sinus surgery. Klebsiella pneumoniae was the most common causative pathogen that was isolated from the gas-containing abscess not related to skull base defect. Among these 11 patients, six underwent excision and five accepted aspiration for the surgical treatment of abscess. In the five patients who underwent aspiration, two required repeated craniotomy to excise the recurrent abscess and repair the abnormal fistulous communication through the skull base. When encountered with a gas-containing abscess in patients with an impaired host defense mechanism, K. pneumoniae infection should be suspected, and further attention should be paid to discovering if other metastatic septic abscesses exist. For patients with a history of basilar skull fracture or surgery involving the skull base, craniotomy is indicated to excise the abscess and repair the potential fistulous communication through the cranium. Aspiration may be a reasonable alternative to treat deep-seated lesions, lesions in an eloquent area, patients with severe concomitant medical disease, or patients without a history of basilar skull fracture or surgery involving the skull base. Prompt diagnosis, appropriate antibiotic use, and meticulous surgical treatment are the only way to obtain a favorable outcome.

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Section: Introductionmentioning

confidence: 99%

Gas‐containing brain abscess: Etiology, clinical characteristics, and outcome

Lan

Lee

et al. 2014

The Kaohsiung J of Med Scie

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Aspiration or extirpation in cerebral abscess surgery?

Kala

1993

Neurosurg. Rev.

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The author carried out CT investigation of 11 patients who recovered after cerebral abscess operation. The finding established in all cases was a hypodensic area of various extensions, which, in 4 patients, made the impression of pseudocysts. Large pathologic lesions were found mainly in the patients in whom healing was complicated by relapse. Surprisingly, rather extensive pathologic changes in the patients were found which were cured by so-called "minimalized surgical intervention". The author imputes these changes to the remaining granulation tissue of the abscess capsula, which worsens conditions for healing. Aspiration is suitable mainly in cases in which the abscess is not -- or only slightly encapsulated. Preoperation CT scans cannot establish exactly the presence and eventual thickness of the capsula. The establishment relationship of the kind and extent of operation to the extent of later cerebral tissue changes in CT findings requires further observation and verification in a larger group of patients.

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