Diagnóstico diferencial entre Glioma y Absceso cerebrales: enseñanzas a partir de un caso / Differential diagnosis between Glioma and Abscess of the brain: teachings from a case

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.

Endocardite mural de átrio esquerdo complicada por abscesso cerebral: relato de caso / Left atrial wall endocarditis complicated y brain abscess: case report

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.

Absceso cerebral en el Hospital Regional Honorio Delgado de Arequipa en el periodo de abril 1965 a abril 1995

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)

Complicaçöes intracranianas das otites médias crônicas supurativas: uma realidade / Intracranial complications of chronic suppurative otitis media: a reality

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.

Les abces et empyemes cerebreaux / Abscess and empyema of the brain

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

Coexistencia de abceso nervioso y lepra tuberculoide: algunas consideraciones sobre la patogenia destes dos processos / Coexistence of nerve abscess and tuberculoid leprosy: some considerations on the pathogenesis of these two processos

El autor despues de hacer algunas consideraciones generales sobre el abseco nervioso, se detiene especialmente en su patogenia, para sostener finalmente que: El abceso nervioso leproso es la lepra tuberculoide del nervio ó mejor aun el granuloma tuberculoide del nervio en franca reacción, semejante a las reacciones observadas en las lesiones tuberculoides de la piel. Que tanto el abceso leproso como la reacción leprosa tuberculoide podrin interpretarse como fenomenos alergicos.