Risk Factors for Brain Abscess in Patients with Congenital Cyanotic Heart Disease

Abstract

Brain abscess is a serious complication of congenital cyanotic heart disease. We retrospectively evaluated the risk factors for brain abscess in 21 such patients treated between 1975 and 1990 in comparison with a control group. The mean arterial oxygen saturation, arterial partial pressure of O2, arterial blood oxygen content, and base excess in patients with brain abscess were significantly lower than in the control patients. The mean arterial partial pressure of CO2, pH, hematocrit, hemoglobin, and red blood cell content in patients with brain abscess were not significantly different. Patients with congenital cyanotic heart disease may develop minute encephalomalacia due to severe hypoxemia and increased blood viscosity resulting from compensatory polycythemia. The increased blood viscosity and reduced blood flow in the microcirculation may induce cerebral thrombosis or exaggerate minute encephalomalacia during dehydration or cardiac dysfunction, and shunted blood containing infectious organisms at such sites may be followed by focal cerebritis.

Brain abscess: surgical experiences of 162 cases

“…In the development of brain abscess, inoculation of an organism is required into the brain parenchyma in an area of devitalized brain tissue or in a region with poor microcirculation, and the lesion evolves from an early cerebritis stage to the stage of organization and capsule formation. [7] Histologically, there are four stages in brain abscess formation: early cerebritis (day 1-3), late cerebritis (day 4-9), early encapsulation (day 10-13) and late capsule stage (day 14 onward). About 2 weeks are required for encapsulation, which is usually less complete on medial or ventricular side due to poor vascular supply.…”

“…[51] Many authors recommended craniotomy and excision for abscesses that enlarge after 2 weeks of antibiotic therapy or that fail to shrink after 3-4 weeks of antibiotics. [1,6,7,45] Craniotomy is also recommended for multiloculated abscesses and larger lesions with significant mass effect that are superficial and located in noneloquent regions of the brain. A few authors also recommended excision of abscesses in the cerebellum, where recurrent pus collection following aspiration can lead to precipitous neurological worsening.…”

Management of brain abscess: an overview

“…8,36,40,54 With the advent of the CT modality in the 1970s, there was a marked decrease in the morbidity and death due to brain abscesses, and this was a result of earlier diagnosis. 8,11,19,25,51,57,64 The mortality rate has decreased by nearly one third from that found in the pre-CT era. 57 Patients with nocardial and listerial brain abscesses have a threefold higher rate of mortality compared to those who die of other causes.…”

“…Altered sensorium with nuchal rigidity may occur in cases of increased mass effect resulting in herniation, or in cases of intraventricular rupture of brain abscess. 54,57 Diagnosis A lumbar puncture is contraindicated in patients with a suspected brain abscess because it can result in transtentorial or transforaminal herniation and subsequent death. 61 Moreover, analysis of cerebrospinal fluid does not aid in diagnosis of an unruptured brain abscess.…”

“…2,8,23,40,54,57 Craniotomy is also recommended for multiloculated abscesses and larger lesions with significant mass effect that are superficial and located in noneloquent regions of the brain. We also recommend excision of abscesses in the cerebellum, where recurrent pus collection following aspiration can lead to precipitous neurological worsening.…”