ABSTRACT
Development of neuroimaging in the last decades has revolutionized the neurological diagnosis, however for they interpretation clinical picture of the patient remains as a relevant aspect. Clinical case: a 30-year-old male patient with recent epileptic seizures, Jaksonian type, secondarily generalized, with no relevant history and normal neurological examination was presented. Initially a Magnetic Resonance of the brain was performed, the case was interpreted as Brain Abscess and treatment with intravenous antimicrobials was instituted for three weeks. A further analysis of the case revolves the diagnosis towards the possibility of a high degree malignant cerebral glioma, which was verified with the accomplishment of a craneotomy and biopsy. Conclusions: focal structural lesions of the brain, such as those caused by neuroepithelial tumors and abscesses, are among the most common causes of Epileptic Syndrome in adulthood. To date, there are no pathognomonic signs in the neuroimagenological differential diagnosis between the two entities. Despite the help of some advanced Magnetic Resonance techniques, the clinical correlation remains as the cornerstone for correct etiological interpretation, as well as pathological examination for the definitive diagnosis of both lesions.
Subject(s)
Humans , Male , Adult , Brain Abscess/diagnosis , Brain Abscess/physiopathology , Magnetic Resonance Imaging/methods , Glioma/surgery , Chile , Diagnosis, Differential , Epilepsy/etiology , Glioma/pathologyABSTRACT
Paciente feminina, 19 anos, foi admitida na emergência com febre diária e cefaleia. Evoluiu com alteração demarcha, de fala, confusão mental, disartria, dispneia, taquicardia, petéquias nas solas e hemorragia subungueal. Realizado ecocardiograma transesofágicoque revelou valva mitral com espessamento de folhetos, falta de coaptação, moderada insuficiência egrande vegetação (10 mm x 4 mm) aderida ao endocárdio da face posterior do átrio esquerdo. Colheu-se hemocultura positiva para Staphylococcus aureus, e a paciente foi diagnosticada com endocarditeinfecciosa pelos critérios de Duke modificados, dando-se início à antibioticoterapia. Ela apresentou boa evolução clínica, entretanto, a febre persistia. Realizou-se tomografia de crânio, que revelou abscesso cerebral.A paciente então foi submetida à drenagem, com resolução da febre.
A 19 year-old female patient was admitted to the ER with daily fever and headache, progressing to altered gait, unclear speech, mental confusion,dysarthria, dyspnea, tachycardia, petechiae on the soles of the feet and subungual hemorrhage.Transesophageal echocardiography shows thickening of the mitral valve leaflets, lack of coaptation, moderate insufficiency and large vegetation (10mm x 4mm) adhering to theendocardium of the posterior left atrial wall. The blood culture was positive for Staphylococcus aureus. The patient was diagnosed with infective endocarditisaccording to the modified Duke criteria, and antibiotic treatment was started. Although progressing well in clinical terms, the fever persisted. Cranial tomography showed a brain abscess that was drained, thus lowering the fever.
Subject(s)
Humans , Female , Young Adult , Brain Abscess/physiopathology , Brain Abscess/therapy , Endocarditis, Bacterial/physiopathology , Endocarditis, Bacterial/therapy , Heart Atria , Echocardiography, Transesophageal/methods , Staphylococcus aureus , Tomography/methodsSubject(s)
Brain Abscess/physiopathology , Cerebellar Diseases/physiopathology , Child , Female , Humans , Rupture, SpontaneousABSTRACT
Se encontró 30 casos (19 varones y 11 mujeres), la incidencia de esta patología se ha mantenido durante estos años a razón de un caso por año, es más frecuente en la segunda y tercera década de la vida; el sindrome frecuente fue el de hipertensión endocraneana 93.3 por ciento. Los sintomas fueron: cefalea 100 por ciento, náuseas y/o vomitos 93.3 por ciento; presentó alza térmica al ingreso 66.67 por ciento, el 20 por ciento presentaron convulsiones. En un porcentaje considerable 40 por ciento no hubo sospecha clínica diagnóstica de absceso cerebral al momento de ingreso. Los focos primarios fueron: traumáticos (11/30), otorrinolaringologías (8/30), hematógeno (6/30), sin foco aparente (5/30). En cuanto a su localización: frontal (13/30), temporal (6/30), parietales (3/30), frontoparietales (3/30), temporo-occipital (3/30), fronto-temporal y temporoparietal el resto; los abscesos cerebrales fueron únicos en el 90 por ciento. Exámenes de laboratorio en el 100 por ciento de los 20 pacientes que se realizó punción lumbar, hubo algún grado de pleocitosis en el líquido cefalorraquideo. El tratamiento fue solo médico (12), médico más quirúrgico (16) y no recibieron (2). La mortalidad fue del 43.3 por ciento, se realizarón cultivos para gérmenes comunes (19/30); fue negativo (8), se aisló estafilococo coagulasa (+) (6), estreptococo hemolítico (2), neumococo (2), estafilococo viridans (1) E. Coli; más estafilococo coagulasa (-) (1)
Subject(s)
Humans , Brain Abscess/pathology , Brain Abscess/physiopathology , Brain Diseases/physiopathology , Cerebrum/pathology , NeurologyABSTRACT
Os autores fazem uma revisao acerca das complicaçoes intracranianas das otites médias crônicas supurativas, chamando a atençao para a ainda alta incidência das mesmas e de sua potencialmente elevada morbi-mortalidade, ilustrando com apresentaçao de casos.
Subject(s)
Humans , Male , Female , Child , Adult , Brain Abscess/etiology , Meningitis/etiology , Otitis Media, Suppurative/complications , Sinus Thrombosis, Intracranial/etiology , Brain Abscess/diagnosis , Brain Abscess/physiopathology , Brain Abscess/therapy , Chronic Disease , Jugular Veins , Meningitis/diagnosis , Meningitis/physiopathology , Meningitis/therapy , Otitis Media, Suppurative/diagnosis , Otitis Media, Suppurative/therapy , Sinus Thrombosis, Intracranial/diagnosis , Sinus Thrombosis, Intracranial/physiopathology , Sinus Thrombosis, Intracranial/therapyABSTRACT
Brain abscess and subdural empyema are serious infections which can be metastasis of chronic suppurative diseases (bronchectasia, lung orabdominal abscess) or of congenital cardiopathy, but they are more frequently seen in healthy adults suffering from chronic sinusitis or otitis. Brain CT scan with contrast media injection is the best tool for diagnosis and follow-up. It has transformed the prognosis of brain abscesses. Anaerobic oropharyngeal microflora is the main source of bacteria responsible for suppurative brain diseases. Surgical treatment consist of aspiration or, rarely now, of excision of the lesion. Medical treatment alone can be successfull in selected cases, provided patients are closely monitored and antibiotics with good penetration into the brain parenchyma are used
Subject(s)
Humans , Brain Abscess/physiopathology , Empyema, Subdural/physiopathology , Anti-Bacterial Agents/pharmacokinetics , Brain Abscess/drug therapy , Brain Abscess/etiology , Brain Abscess/surgeryABSTRACT
From a total of 70 cases of brain abscess operated in 15 years, the authors have studied 50 cases and tell us their experience. These brain abscess are mainly found within young males and are often secondary to either head injuries or O.R.L. infections. After a brief study on the anatomical evolution of brain abscess, the authors discuss the diagnosis methods which have been recently improved through the C.A.T. The treatment of brain abscess is based on associated and adapted antibiotherapy with a total surgical excision. This is the only efficient method to improve the prognosis which still now a days remains very serious with death rate between 30 and 50% in most statistics [42% in our cases]