Intracranial suppuration

Abstract

Objective: To evaluate prevalence, age, position, predisposing factors, bacteriology, clinical features and outcomes of children with subdural empyema (SDE) and brain abscess (BA). Design: Retrospective hospital‐based study in a tertiary children's hospital. Methods: Clinical data were reviewed on all children classified as having SDE or BA for 10.75 years from 1 January 1992 to 31 August 2003 at the Royal Alexandra Hospital for Children, Sydney, Australia. Results: Forty‐six children with intracranial suppuration were identified: 26 had BA, 16 had SDE and four children had both SDE and BA. Significant differences between SDE and BA were that: sinusitis was a predisposing factor for SDE (P = 0.01), Streptococcus milleri was the main organism isolated in SDE (P = 0.02), periorbital oedema (P = 0.005) and photophobia (P = 0.02) were clinical features specifically associated with SDE, and 75% of multiple abscesses were in females (P = 0.005). The age distribution of SDE was biphasic, with peaks at <2 years and >7 years. Cases of BA peaked at age 9–11 years. Forty‐eight per cent of all children were between 9 and 13 years old; 20% were <1 year old. All the children with SDE and BA were aged 1 year or less. Three of the 46 children died, all with BA. Eighteen (39.1%) returned to normal and 25 (54.3%) had neurological complications. Neurological complications were more common in the BA group. Conclusion: The mortality rate of intracranial suppuration is low, but morbidity remains high. A high degree of suspicion is needed to diagnose and treat intracranial infections early.

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

“…1,[25][26][27][28][29]31,[34][35][36][37][38][39][40][41][42][43][44][45][48][49][50][51][52][53][54][56][57][58][59][60] Many of these reports are inhomogeneous with respect to etiology, including infectious collections related to community-acquired meningitis, congenital heart disease, trauma, and previous surgery. Many reports limited to complications of sinusitis include orbital cellulitis, dural sinus thrombophlebitis, and meningitis, which were not considered in the current study.…”

Brain abscesses in Malawian children: value of CT scan

“…It is also useful for diagnosing subdural collections which are common in children ,2 years of age. 2 This diagnosis is not uncommon in our setting where the usual cause is non-typhoidal salmonella (S. M. Graham, unpublished observation) and repeated needle aspiration through the fontanelle is a part of management. Brain abscess is typically seen in older children 2,3 and so ultrasound is not helpful for diagnosis.…”

“…Recent retrospective studies from two tertiary referral hospitals in Pakistan and Australia each reported 30 cases over a 10-year period. 2,3 Most were children over 4 years of age, case fatality was 10-16% and the majority of survivors had longstanding neurological deficit. A recent review states that 25% of all brain abscesses occur in children under the age of 15 years with a peak at 4-7 years and high morbidity and mortality.…”

Frontal sinus mini-trephination for acute sinusitis complicated by intracranial infection

“…A review by Younis et al found the opposite to be the case [5]. Taken from a different perspective, Leotta et al [2] found that in all their cases of subdural empyema, this was more likely to arise secondary to acute sinusitis. This also highlights the importance of imaging of the sinuses in cases where the imaging is usually focussed upon the intracranial infection [7].…”

“…This is particularly so when acute sinusitis is the initiating illness because of common clinical features such as headache, fever, and vomiting. [2,3] The process usually rapidly progresses with variable development of meningism, focal neurology, altered conscious state, and seizures [4]. The role of neurosurgical intervention is established, but the issue of the timing and nature, if any, of surgical management of the sinuses in the acute setting remain unresolved.…”