ABSCESO CEREBRAL EN NIÑOSRevisión Medline 1995 – 2000Cyberpediatria Treatment of bacterial brain abscess by repeated aspiration--follow up by serial computed tomography.AUTHORS: Yamamoto M; Fukushima T; Hirakawa K; Kimura H; Tomonaga MAUTHOR AFFILIATION:Department of Neurosurgery, Fukuoka University School of Medicine.ABSTRACT:
Bacterial brain abscess often
requires repeated aspiration before the abscess finally resolves. However,
there are no guidelines for treatment by aspiration; for example, when should
the abscess be tapped again, or when can an abscess be treated by antibiotics
alone without further aspiration. Eleven patients with bacterial brain abscess
treated by aspiration were evaluated to establish treatment guidelines for
brain abscess, in particular the abscess size on serial computed tomography
(CT) after aspiration. CT was performed about 24 hours after aspiration to
evaluate the size of the abscess, and almost weekly during follow up. The
diameter of the brain abscess before and after the initial and last aspirations
were reviewed. In eight of the 11 patients, abscesses were aspirated
repeatedly: two to three times in most patients. The diameter of the abscesses
was 2.5-4.5 cm (mean 3.5 cm) before the last aspiration, and 1.4-3.4 cm (mean
2.3 cm) after the last aspiration, or when continuous drainage was
discontinued. Perifocal edema was moderately decreased within 3 weeks after the
last aspiration by medical treatment alone, with a concomitant decrease in the
volume of the abscess. There were no deaths, and most patients had a favorable
outcome. These results suggest that after the diameter of the abscess becomes
less than 2 to 3 cm and does not increase anymore on serial CT, medical
treatment alone can be anticipated to give satisfactory results without further
aspiration.
SOURCE: Neurol Med Chir (Tokyo) 2000 Feb;40(2):98-104; discussion 104-5 Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy in the differential diagnosis of cerebral abscesses.
AUTHORS: Spinelli F; Sara R; Milella M; Ruffini L; Sterzi R; Causarano IR; Sberna MAUTHOR AFFILIATION:Department of Nuclear Medicine, Niguarda Ca' Granda Hospital, Milan, Italy.ABSTRACT:The diagnosis of brain abscess is often difficult, as the clinical symptoms are not specific. Computed tomography (CT) and magnetic resonance imaging (MRI) are highly sensitive, but different cerebral lesions, especially neoplasms, can have the same ring-like contrast enhancement. Brain abscess is a severe illness requiring rapid diagnosis to choose the most appropriate therapy. Technetium-99m hexamethylpropylene amine oxime (HMPAO)-labelled leucocyte scintigraphy is commonly used to detect an inflammatory process. The aim of this study was to present the results obtained with leucocyte scintigraphy in 65 patients with intracranial mass lesions and clinical findings compatible to or suggestive of brain abscess. The final diagnosis, based on surgery, clinical findings and stereotatic puncture, was brain abscess in 17 patients, primary brain neoplasm in 22, brain metastasis in 16, lymphoma in 2, cysticercosis in 2, hematoma in 2 and cerebral infarction in 4. 99mTc-HMPAO leucocyte scintigraphy was positive in all abscess cases. The scan was negative in the rest of the patients examined, with the exception of one lesion, which was finally diagnosed as a tumour (1 false-positive). All patients who did not have false-negative scans were treated with steroids. The sensitivity, specificity and diagnostic accuracy of leucocyte scintigraphy was 100%, 97.8% and 98.4%, respectively. In conclusion, in our experience, leucocyte scintigraphy is a valuable aid in the differential diagnosis between abscess and neoplasm.SOURCE: Eur J Nucl Med 2000 Jan;27(1):46-9 Salmonella meningitis and multiple cerebral abscesses in an infant.
AUTHORS: Workman MR; Price EH; Bullock PAUTHOR AFFILIATION:Department of Medical Microbiology, King's College School of Medicine and Dentistry, London, UK.ABSTRACT:The history of a 4-week-old infant with meningitis and multiple cerebral abscesses caused by Salmonella enteritidis is reported. Management included successful treatment with a prolonged course of antibiotics, including ciprofloxacin, neurosurgical drainage and long-term immunoglobulin supplements. No adverse effects of joint toxicity were detected.SOURCE: Int J Antimicrob Agents 1999 Oct;13(2):131-2 Meningitis caused by streptococci other than Streptococcus pneumoniae: a retrospective clinical study.AUTHORS: Moller K; Frederiksen EH; Wandall JH; Skinhoj PAUTHOR AFFILIATION:Department of Infectious Diseases, Rigshospitalet, Copenhagen, University Hospital, Denmark.ABSTRACT:We reviewed the medical records of 26 patients (median age 62 years, range 5-76 years) admitted to our institution during 1978-98 with acute bacterial meningitis (ABM) caused by streptococci other than Streptococcus pneumoniae (comprising 1.9% of all patients with ABM). 19 cases were community-acquired and 7 were nosocomial. 73% had comorbid or predisposing conditions and 73% had an identifiable extracerebral focus; only in 2 patients no comorbid disease, primary focus or predisposing condition was present. Five patients had cerebral abscesses, and 5 had endocarditis. Beta-haemolytic streptococci were grown in 14 cases (serotype A: 4, B: 5, C: 1, G: 4) and were predominant among patients with endocarditis, whereas alpha-or non-haemolytic strains grew in 12 cases (S. mitis: 4, S. constellatus: 2, E. faecalis: 2, S. bovis: 1, unspecified: 3) and were predominant in patients with a brain abscess. Staphylococcus aureus grew together with a streptococcus in 2 cases. Blood culture was positive in 9 cases (35%). Neurologic complications occurred in 11 patients (42%) and extraneurologic complications in 18 patients (69%). Adverse outcomes occurred in 10 patients (38%), including 3 patients who died. Occurrence of seizures at any time of disease was significantly associated with an adverse outcome; no other clinical or paraclinical features appeared to affect outcome.SOURCE: Scand J Infect Dis 1999;31(4):375-81 Diagnostic assessment of brain tumours and non-neoplastic brain disorders in vivo using proton nuclear magnetic resonance spectroscopy and artificial neural networks.AUTHORS: Poptani H; Kaartinen J; Gupta RK; Niemitz M; Hiltunen Y; Kauppinen RAAUTHOR AFFILIATION:NMR Research Group, A.I. Virtanen Institute, University of Kuopio, Finland.ABSTRACT:PURPOSE: Experiments were carried out to assess the potential of artificial neural network (ANN) analysis in the differential diagnosis of brain tumours (low- and high-grade gliomas) from non-neoplastic focal brain lesions (tuberculomas and abscesses), using proton magnetic resonance spectroscopy (1H MRS) as input data. METHODS: Single-voxel stimulated echo acquisition mode (STEAM) (echo time of 20 ms) spectra were acquired from 138 subjects including 15 with low-grade gliomas, 47 with high-grade gliomas, 18 with tuberculomas, 18 with abscesses and 40 healthy controls. Two neural networks were constructed using the spectral points from 0.6 to 3.4 parts per million. In the first network construction, the ANN had to differentiate between tumours from infections, while the second network had to differentiate between all five histological classes.RESULTS: ANN analysis gave a histologically correct diagnosis for low- and high-grade gliomas with an accuracy of 73% and 98% respectively. None of the 62 tumours was diagnosed as an infectious lesion. Among the non-neoplastic lesions, ANN classification was correct in 89% of tuberculomas and in 83% of brain abscesses. The specificity of ANN diagnosis was 98%, 92%, 99%, and 100% for low-grade gliomas, high-grade gliomas, tuberculomas and abscesses respectively. CONCLUSION: The present data show the clinical utility of non-invasive 1H MRS by automated ANN analysis in the diagnosis of tumour and non-tumour cerebral disorders.SOURCE: J Cancer Res Clin Oncol 1999;125(6):343-9 [Purulent meningoencephalitis treated in the Infectious Diseases Clinic of the Silesian Medical]
Academy in Bytom in 1994-1995:personal observationsAUTHORS: Kepa L; Stolarz W; Adamek BAUTHOR AFFILIATION:I Klinika Chorob Zakaznych Slaskiej Akademii Medycznej w Bytomiu.ABSTRACT:Among 267 patients with central nervous system infections, 43 patients (16.1%) suffered from purulent bacterial meningitis. An etiological agent was established in 15 cases (34.9%): Str. pneumoniae--9 cases, N. meningitidis--4 cases and Staph. aureus--2 cases. Most patients had severe course of the disease; lethality was 18.6%, the recovery with subsequent sequelae was noted in 11.6% cases, and 69.8% cases fully recovered. In two patients brain abscess and intracranial empyema, and persistent cerebral ischaemia were found, one of these patients died. Frequent use of antibiotics before hospitalization reduces the possibility of establishing the etiological agent. Bacterial infections of the central nervous system are still danger diseases producing high lethality and subsequent neurological sequelae.SOURCE: Przegl Epidemiol 1997;51(3):297-302 Current treatment of brain abscess in patients with congenital cyanotic heart disease.AUTHORS: Takeshita M; Kagawa M; Yato S; Izawa M; Onda H; Takakura K; Momma KAUTHOR AFFILIATION:Department of Neurosurgery, Heart Institute of Japan, Tokyo Women's, Medical College, Japan.ABSTRACT:
OBJECTIVE: The
goal of this study was to define clearly the role of management in patients
with cyanotic heart disease and brain abscesses by evaluating retrospectively
the factors influencing poor outcome in these patients. METHODS: This study
included 62 patients with cyanotic heart disease and brain abscesses diagnosed
in the computed tomography era. Basic characteristic parameters (number, size,
location, computed tomographic classification and organism type of abscess,
convulsion, type of cyanotic heart disease, age distribution, immunocompromised
status, pretreatment neurological state, and intraventricular rupture of brain
abscess [IVROBA]) and therapeutic parameters (type of antibiotics and duration
of administration, steroid medication and therapeutic modalities, aspiration
with or without cerebrospinal fluid drainage, total extirpation after
aspiration, or primary extirpation and medical treatment) were evaluated as
independent predictors of poor outcome (totally disabled state or death) by
using univariate and multivariate logistic regression analysis. We also
statistically estimated the possible causes of IVROBA and the multiplicity of
brain abscess. RESULTS: Although there were no statistically significant correlations
between patients with good and poor outcomes in regard to other basic
characteristic and therapeutic parameters, patients with poor outcomes were
older (P < 0.02), more frequently had IVROBA (P < 0.005), and had a
higher frequency of neurological deterioration (P < 0.01) than those with
good outcomes. Multiple logistic regression analysis predicted that poor
outcome increased the relative risk of IVROBA by a factor of 18.9 (odds rate,
18.9; 95% confidence interval, 1.7-211.6; P < 0.02). More patients with multiple
abscesses had positive immunocompromised states than those with single
abscesses (P < 0.01). Deep-located abscesses also more frequently had IVROBA
(P < 0.005) and abscesses located in the parieto-occipital region ruptured
into the occipital horn of the lateral ventricle in a short period (P <
0.02). CONCLUSIONS: Our findings suggest that IVROBA strongly influences poor
outcome in patients with cyanotic heart disease. The key to decreasing poor outcomes
may be the prevention and management of IVROBA. To reduce operative and
anesthetic risk in these patients, abscesses should be managed by less invasive
aspiration methods guided by computed tomography. Abscesses larger than 2 cm in
diameter, in deep-located or parieto-occipital regions, should be aspirated
immediately and repeatedly, mainly using computed tomography-guided methods to decrease
intracranial pressure and avoid IVROBA. IVROBA should be aggressively treated
by aspiration methods for the abscess coupled with the appropriate intravenous
and intrathecal administration of antibiotics while evaluating intracranial
pressure pathophysiology.
SOURCE: Neurosurgery 1997 Dec;41(6):1270-8;
discussion 1278-9
[Factors associated with the prognosis of bacterial meningitis in children]AUTHORS: Takayanagi M; Yamamoto K; Nakagawa H; Iinuma KAUTHOR AFFILIATION:Department of Pediatrics, Tohoku University School of Medicine, Sendai.ABSTRACT:Treatment of bacterial meningitis depends on its severity. The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value. The overall mortality rate was 3.9%. The incidence of neurological deficit on discharge was 31.4%. According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis). An analysis of these groups using Fisher’s exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l. Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S. pneumoniae. The incidence of poor prognosis was also high in S. pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%). In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified. In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.SOURCE: No To Hattatsu 1997 Jul;29(4):291-7 [Cerebral abscess. Clinical review of 26 cases]AUTHORS: Estirado de Cabo E; Arzuaga Torre JA; Roman Garcia F del Pozo Garcia JM; Perez Maestu R; Martinez Lopez de Letona JAUTHOR AFFILIATION:Servicio de Medicina Interna II, Clinica Puerta de Hierro, Universidad Autonoma de Madrid.ABSTRACT:BACKGROUND. The introduction of new diagnostic and therapeutic techniques has changed the clinical attitude and consequences of brain abscesses (BA). OBJECTIVE. To analyse clinical-radiological features, therapy, prognostic factors and evolution of BA in our institution. MATERIALS AND METHODS. Retrospective study of all clinical records of patients diagnosed with BA from 1982 to 1992. RESULTS. Twenty-six patients with a mean age of 46.2 years were selected. The incidence was 2.6 patients/10,000 admission/year. Among 17 patients (65%) some extraprenchymatous infectious focus was found, which was located at the otorhynolaryngeal area in twelve patients. Mean duration of symptoms was 12.9 days, headache being the most common of them (69%). With CT 18 patients had a single mass, eight patients multiple masses, and 21 patients a ring enhancement when the contrast material was introduced. The causative organism was recovered from 15 patients. The organism recovered more frequently were Streptococcus spp, Enterobacteriaceae and Staphylococcus aureus. Twenty patients (77%) underwent surgical therapy, which consisted in ablation (12) or drainage (8). All patients received antibiotics for a mean of 37 days: the most frequent antibiotic combination used was penicillin+chloramphenicol. Six patients died (23%) and 7 remained with sequelae. Although statistically non-significant, the acute presentation was associated with a higher mortality rate, and the use of dexamethasone was associated with a lower mortality rate (p = 0.053 and 0.062, respectively). CONCLUSIONS. BA is associated with a high mortality rate and a high sequelae rate despite appropriate diagnostic and therapeutic measures. ORL infection is the most frequent predisposing factor. The use of dexamethasone is not associated with a higher mortality rate.SOURCE: Rev Clin Esp 1995 May;195(5):304-7 Cerebrospinal fluid beta 2-microglobulin in neonates with central nervous system infections.AUTHORS: Garcia-Alix A; Martin-Ancel A; Ramos MT; Salas S; Pellicer A; Cabanas F; Quero JAUTHOR AFFILIATION:La Paz Children's Hospital, Neonatology Division, Madrid, Spain.ABSTRACT:Beta 2-microglobulin (beta 2m) determination in CSF of 72 neonates who underwent a spinal tap as part of a sepsis or meningo-encephalitis workup was performed to evaluate the usefulness of this test in the diagnosis of CNS infections. Beta 2m was measured by enzyme immunoassay. Sixty neonates had sterile culture and normal neurological status at discharge. Twelve infants had CNS infections: 8 bacterial meningitis, 3 TORCH infections (T = toxoplasmosis, O = others, R = rubella, C = cytomegalovirus and H = herpes simplex) and 1 viral meningitis. Neonates with CNS infection exhibited significantly higher CSF beta 2m levels compared to neonates with sterile culture (6.24 +/- 2.66 vs 1.74 +/- 0.5 mg/l; P < 0.0001). CSF beta 2m levels did not correlate with the white cell count, total protein concentration or glucose level in CSF. When serum and CSF levels were measured simultaneously, the CSF beta 2m level was significantly higher than the corresponding serum level in patients with CNS infection (6.98 +/- 2.5 vs 3.2 +/- 0.25 mg/l; P < 0.01). Sensitivity, specificity, and predictive values were estimated for different cut-off points. The best operational diagnostic cut-off value was 2.25 mg/l. Receiver operating characteristic curve analysis showed an appropriate trade-off between specificity and sensitivity and indicated that CSF beta 2m was accurate in distinguishing between neonates with and without CNS infection. Conclusion. CSF beta 2m may be a useful ancillary tool in neonates when CNS infection is suspected.SOURCE: Eur J Pediatr 1995 Apr;154(4):309-13