ABSTRACT
OBJECTIVE: To suggest a comprehensive algorithm for the surgical approach for correcting of sources of temporal bone CSF leaks. METHODS: A case series for patients operated in a single academic tertiary referral center between 2011 and 4.2022. Included in the study were 46 patients, 5 of whom had a bilateral problem, resulting in 51 pathologic temporal bones. The presentation was an active CSF leak (38 patients) or bacterial otogenic meningitis (8 patients). Follow up ranged from 8 months to 5 years. RESULTS: Of the 42 ears operated via the default middle fossa approach, 37 were successful (88 %) in controlling CSF leak. None had intracranial complications or sensorineural hearing loss. Location, number and size of the defects, hearing status, associated superior semicircular canal dehiscence, additional intra-temporal or intra-cranial pathologies may indicate a transmastoid approach. Of the six ears that had a canal wall up mastoidectomy as a primary procedure, one required revision due to ongoing CSF leak. Five revision cases and three primary cases were effectively sealed with a subtotal petrosectomy and obliteration. One was lost to follow-up. Hearing was reconstructed with bone-anchored hearing implants in 6 out of these 8 ears. CONCLUSIONS: The middle fossa approach could be used as a default approach for sealing TD. There are a number of indications for transmastoid approaches in both primary and revision cases. Obliteration of the ear was used in all revision cases. The suggested algorithm can help in planning surgery for temporal bone CSF leaks or a history of otogenic meningitis.
Subject(s)
Algorithms , Cerebrospinal Fluid Leak , Temporal Bone , Humans , Temporal Bone/surgery , Male , Female , Middle Aged , Adult , Cerebrospinal Fluid Leak/surgery , Cerebrospinal Fluid Leak/etiology , Treatment Outcome , Aged , Follow-Up Studies , Young Adult , Meningitis, Bacterial/surgery , Mastoidectomy/methods , Retrospective Studies , Adolescent , Otologic Surgical Procedures/methodsABSTRACT
Basilar artery dissections are rare events which present with subarachnoid hemorrhage (SAH), brain ischemia, and usually have a fatal outcome. Few case reports of mycotic dissections are published in literature. We report a case of a young male who underwent surgical treatment for post-traumatic CSF rhinorrhea. He presented 3 years later with signs of bacterial meningitis. During medical management with antibiotic therapy, he developed basilar artery aneurysm in a span of 2 days, had subarachnoid hemorrhage and deteriorated. CSF culture grew alpha hemolytic streptococci. Despite medical management, he developed brain stem infarcts and succumbed. This report highlights a rare fatal complication of mycotic dissecting aneurysm of the basilar artery following meningitis, which developed acutely in hospital, while on treatment. Antibiotic therapy had not altered the course of disease. It is advisable to investigate for presence of ruptured mycotic aneurysms or dissection in cases of bacterial meningitis leading to SAH.
Subject(s)
Aneurysm, Ruptured/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Intracranial Aneurysm/surgery , Meningitis, Bacterial/surgery , Adult , Aortic Dissection/surgery , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnosis , Cerebral Angiography/methods , Cerebrospinal Fluid Rhinorrhea/diagnosis , Humans , Male , Meningitis, Bacterial/complications , Postoperative PeriodABSTRACT
Meningitis is a rare but serious complication in patients with Currarino syndrome. We present a 6-year-old girl with a fulminant meningitis due to an enterothecal fistula involving the anterior sacral meningocele. Initial treatment consisted of broad-spectrum intravenous antibiotic therapy and laparoscopic construction of a deviating double-loop ileostomy. This was followed by an elective posterior neurosurgical approach with a sacral laminectomy, evacuation of the empyema, and securing the disconnection of the anterior meningocele from the thecal sac, 10 days after initial hospital admission. The girl made a good postoperative recovery. The treatment strategy in the setting of meningitis due to an inflamed anterior meningocele is discussed and the available literature on the topic is reviewed.
Subject(s)
Anal Canal/abnormalities , Anti-Bacterial Agents/therapeutic use , Digestive System Abnormalities/complications , Ileostomy , Laminectomy , Meningitis, Bacterial/etiology , Rectum/abnormalities , Sacrum/abnormalities , Syringomyelia/complications , Anal Canal/surgery , Child , Digestive System Abnormalities/drug therapy , Digestive System Abnormalities/surgery , Female , Humans , Laparoscopy , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/surgery , Rectum/surgery , Sacrum/surgery , Syringomyelia/drug therapy , Syringomyelia/surgeryABSTRACT
OBJECT: This paper is aimed to explore a reasonable guideline for distinguishing whether post-neurosurgical bacterial meningitis has completely been cured, so as to avoid the deficient or excessive treatment for post-neurosurgical bacterial meningitis. PATIENTS AND METHODS: We conducted a retrospective analysis of 46 patients who attended General Hospital of Chinese People's Armed Police Force in Beijing, China, from January 1, 2014 to April 30, 2016. The CSF leukocyte, polykaryocyte, protein and glucose had been tested when their antibiotic treatments were empirically stopped. Between the non-relapse and relapse groups, Wilcoxon Rank Sum test was used to compare the differences of CSF leukocyte and polykaryocyte, and t-test was applied to contrast the distinctions of CSF protein and glucose, then, the thresholds of significant items were estimated by ROC curve. RESULTS: The CSF leukocyte counts in non-relapse group are 23.72 ± 14.12/mm3, which are statistically less than the relapse group's (47.00 ± 1.00/mm3, P = 0.014), so does the CSF polykaryocyte counts (1.74 ± 4.84/mm3 &4.67 ± 1.15/mm3, P = 0.012). Between the two groups, the AUCs of leucocyte and polykaryocyte are 0.926 (95% CI = 0.845-1.0, P = 0.014) and 0.884 (95%CI = 0.786-0.982, P = 0.028), respectively. Their critical values are 44/mm3 (sensitivity = 1, specificity = 0.907) and 3/mm3 (sensitivity = 1, specificity = 0.837). Conversely, CSF protein and glucose have no statistic differences between the two groups. CONCLUSION: Both CSF leukocyte and polykaryocyte can satisfactorily indicate whether the post-neurosurgical bacterial meningitis has completely been cured, 0-44/mm3 is recommended as the reference range of CSF leukocyte, and the CSF polykaryocyte' s is 0-3/mm3.
Subject(s)
Bacterial Proteins/cerebrospinal fluid , Giant Cells/metabolism , Glucose/cerebrospinal fluid , Leukocytes/metabolism , Meningitis, Bacterial/cerebrospinal fluid , Neurosurgical Procedures/trends , Adolescent , Adult , Aged , Biomarkers/cerebrospinal fluid , Female , Humans , Male , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/surgery , Middle Aged , Retrospective Studies , Young AdultABSTRACT
Austrian syndrome is a triad characterized by pneumonia, meningitis and endocarditis, as a result of a Streptococcus pneumoniae bacteremia. We report a previously healthy 49 year-old male, who consulted at the emergency care unit with a history of one week of pleuritic pain, fever leading to an altered level of consciousness and seizures. A diagnosis of community-acquired pneumonia and meningitis was reached, isolating Streptococcus pneumoniae in the cerebrospinal fluid and blood cultures. Antibiotic treatment was started but the patient had an unsatisfactory response. During hospitalization a new heart murmur was found in the physical examination. An echocardiography was performed and a massive aortic valve insufficiency was found along with vegetations and a perforation of the same valve. The valve was replaced by a prosthetic one and the patient responded satisfactorily to the surgical and antibiotic treatment, without complications.
Subject(s)
Humans , Male , Middle Aged , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Meningitis, Bacterial/microbiology , Endocarditis, Bacterial/microbiology , Pneumonia, Pneumococcal/surgery , Pneumonia, Pneumococcal/diagnostic imaging , Syndrome , Tomography, X-Ray Computed , Meningitis, Bacterial/surgery , Meningitis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnostic imagingABSTRACT
RATIONALE: Bacterial meningitis (BM) has been recognized as a rare complication of spinal surgery. However, there are few reports on the management of postoperative BM in patients who have undergone spinal surgery. The initial approach to the treatment of patients suspected with acute BM depends on the stage at which the syndrome is recognized, the speed of the diagnostic evaluation, and the need for antimicrobial and adjunctive therapy. PATIENT CONCERNS: Here, we report the case of a patient with lumbar spinal stenosis and underwent a transforaminal lumbar interbody fusion at L4-L5. The dura mater was damaged intraoperatively. After the surgery, the patient displayed dizziness and vomiting. A CSF culture revealed Pseudomonas aeruginosa infection. DIAGNOSES: The patient was diagnosed with postoperative BM. INTERVENTIONS: Antibiotic was administered intravenously depends on the organism isolated. Nevertheless, the patient's clinical condition continued to deteriorate. The patient underwent 2 open revision surgeries for dural lacerations and cyst debridement repair. OUTCOMES: The patient's mental status returned to normal and her headaches diminished. The patient did not have fever and the infection healed. LESSONS: Surgical intervention is an effective method to treat BM after spinal operation in cases where conservative treatments have failed. Further, early surgical repair of dural lacerations and cyst debridement can be a treatment option for selected BM patients with complications including pseudomeningocele, wound infection, or cerebrospinal fluid leakage.
Subject(s)
Lumbar Vertebrae/surgery , Meningitis, Bacterial/surgery , Postoperative Complications/surgery , Spinal Fusion/adverse effects , Spinal Stenosis/surgery , Female , Humans , Middle Aged , Postoperative Complications/etiologySubject(s)
Endocarditis, Bacterial/microbiology , Meningitis, Bacterial/microbiology , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/surgery , Humans , Male , Meningitis, Bacterial/diagnostic imaging , Meningitis, Bacterial/surgery , Middle Aged , Pneumonia, Pneumococcal/diagnostic imaging , Pneumonia, Pneumococcal/surgery , Syndrome , Tomography, X-Ray ComputedSubject(s)
Bacteroidaceae Infections/etiology , Campylobacter Infections/etiology , Campylobacter rectus/isolation & purification , Coinfection/microbiology , Fusobacterium Infections/etiology , Fusobacterium necrophorum/isolation & purification , Gram-Positive Bacterial Infections/etiology , Meningitis, Bacterial/microbiology , Peptostreptococcus/isolation & purification , Periodontal Abscess/complications , Porphyromonas gingivalis/isolation & purification , Aged , Anti-Bacterial Agents/therapeutic use , Bacteroidaceae Infections/drug therapy , Bacteroidaceae Infections/microbiology , Campylobacter Infections/drug therapy , Campylobacter Infections/microbiology , Coinfection/drug therapy , Combined Modality Therapy , Drainage , Drug Therapy, Combination , Fatal Outcome , Female , Fusobacterium Infections/drug therapy , Fusobacterium Infections/microbiology , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/microbiology , Humans , Leukocytosis/etiology , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/surgery , Periodontal Abscess/microbiologyABSTRACT
BACKGROUND: Intracranial infectious aneurysms (IAs) are rare cerebrovascular lesions that represent only 1%-6% of all intracranial aneurysms. IAs are rare cerebrovascular lesions and pose a significant therapeutic challenge because of their angiographic and pathophysiologic features. We describe a patient with an intracranial IA treated by the use of reconstructive endovascular methods using a balloon-expandable covered stent and discuss the pathophysiologic characteristics of IA based on serial brain imaging findings. CASE DESCRIPTION: A 21-year-old man was admitted to our emergency department with headache and vomiting. Neurologic examination, hematologic workup, and cerebrospinal fluid examination confirmed a diagnosis of bacterial meningitis. Initial brain magnetic resonance angiography revealed no significant stenosis lesions or aneurysm. After 4 weeks of antibiotic treatment, follow-up brain magnetic resonance imaging revealed an 8-mm sized aneurysm on the petrous portion of the right internal carotid artery, and 3 months later, follow-up brain magnetic resonance angiography revealed that the aneurysm had increased in size from 8 to 15 mm. Conventional 4-vessel angiography confirmed the presence of a pseudoaneurysm. Endovascular treatment was then planned via the use of a balloon-expandable covered stent. Postoperatively, the patient was discharged without specific neurologic deficit. CONCLUSIONS: IAs are rare cerebrovascular lesions and pose a significant therapeutic challenge because of their angiographic and pathophysiologic features. Although endovascular treatment is not performed routinely for infectious aneurysms, the covered stent may represent a safe and effective treatment that achieves complete endoluminal reconstruction of the damaged vessel wall.
Subject(s)
Aneurysm, Infected/surgery , Endovascular Procedures/methods , Intracranial Aneurysm/surgery , Klebsiella Infections/surgery , Meningitis, Bacterial/surgery , Plastic Surgery Procedures/methods , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Endovascular Procedures/instrumentation , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/microbiology , Klebsiella Infections/diagnostic imaging , Klebsiella Infections/microbiology , Male , Meningitis, Bacterial/diagnostic imaging , Meningitis, Bacterial/microbiology , Plastic Surgery Procedures/instrumentation , Stents , Treatment Outcome , Young AdultSubject(s)
Mastoiditis/diagnosis , Meningitis, Bacterial/diagnosis , Osteitis/diagnosis , Otitis Media/diagnosis , Petrositis/diagnosis , Streptococcal Infections/diagnosis , Streptococcus milleri Group/isolation & purification , Aged , Diagnosis, Differential , Humans , Male , Mastoiditis/microbiology , Mastoiditis/surgery , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/surgery , Osteitis/microbiology , Osteitis/surgery , Otitis Media/microbiology , Otitis Media/surgery , Petrositis/microbiology , Petrositis/surgery , Streptococcal Infections/microbiology , Streptococcal Infections/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult. CASE REPORT: We report the case of a 41-year-old African man affected by neurosyphilis that manifested itself through a meningovascular chronic inflammatory process, with the peculiar feature of a bilateral aneurysm of probable mycotic origin involving the distal tract of A2 segment of both anterior cerebral arteries. CONCLUSIONS: Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.
Subject(s)
Anterior Cerebral Artery/surgery , Intracranial Aneurysm/complications , Intracranial Aneurysm/surgery , Meningitis, Bacterial/complications , Meningitis, Bacterial/surgery , Neurosyphilis/complications , Neurosyphilis/surgery , Vasculitis, Central Nervous System/complications , Vasculitis, Central Nervous System/surgery , Adult , Biopsy , Humans , Intracranial Aneurysm/diagnosis , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/diagnosis , Neurosurgical Procedures , Neurosyphilis/diagnosis , Treatment Outcome , Vasculitis, Central Nervous System/diagnosisABSTRACT
A 52-year-old woman with a 6-month history of prednisolone treatment for suspected diagnosis of myositis presented 3 months after withdrawal of steroids with headache, nuchal rigidity, fever, nausea, and vomiting. While routine blood work was unremarkable, CSF analysis was consistent with bacterial meningitis. MRI confirmed a non-enhancing pituitary cystic lesion that had been incidentally diagnosed 6 years earlier as a suspected Rathke's cleft cyst (RCC). Under the suspected diagnosis of RCC empyema, the patient underwent transsphenoidal surgery. Neuropathological examination revealed purulent material containing gram-positive cocci within a RCC.
Subject(s)
Central Nervous System Cysts/complications , Central Nervous System Cysts/surgery , Meningitis, Bacterial/complications , Meningitis, Bacterial/surgery , Anti-Inflammatory Agents/therapeutic use , Female , Gram-Positive Bacterial Infections/microbiology , Humans , Magnetic Resonance Imaging , Middle Aged , Myositis/drug therapy , Neurosurgical Procedures , Prednisolone/therapeutic useABSTRACT
BACKGROUND: Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. MATERIAL AND METHODS: Patients who had PM complicated by SE in the Children's Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. RESULTS: Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. CONCLUSIONS: For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases.
Subject(s)
Meningitis, Bacterial/surgery , Subdural Effusion/complications , Craniotomy , Drainage/methods , Female , Humans , Infant , Infant, Newborn , Intracranial Pressure , Leukocyte Count , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/complications , Neurosurgical Procedures/methods , Postoperative Complications/etiology , Recurrence , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the third ventricular floor. Only eight cases have been published. In this report, a case of presumably Rathke's cleft cyst associated with cerebrospinal fluid leakage caused by PEIR is described. An 81-year-old woman underwent endoscopic transsphenoidal surgery for the intra- and supra-sellar cystic lesion. Intraoperatively a hole was confirmed over the sella turcica connecting the sellar cyst and the infundibular recess. Liquorrhea did not occur throughout the procedure. A computed tomography (CT) scan obtained immediately after surgery disclosed accumulation of air in the third and lateral ventricles, in addition to the intra- and supra-sellar region. Air accumulation resolved spontaneously after bed rest for 11 days and she was discharged without neurological deficits. However, she required the second transsphenoidal surgery to repair the sellar floor because of bacterial meningitis caused by liquorrhea on the postoperative day 23. A postoperative 3-tesla magnetic resonance image revealed a deep infundibular recess connecting the sella turcica and the third ventricle, which was considered to be PEIR. To the best our knowledge, this is the first reported case describing the intraoperative findings of PEIR.
Subject(s)
Central Nervous System Cysts/diagnosis , Cerebrospinal Fluid Leak/diagnosis , Cerebrospinal Fluid Leak/surgery , Endoscopy , Pituitary Gland, Posterior/abnormalities , Pituitary Neoplasms/diagnosis , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Aged, 80 and over , Central Nervous System Cysts/surgery , Female , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/surgery , Magnetic Resonance Imaging , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/surgery , Pituitary Gland, Posterior/embryology , Pituitary Neoplasms/surgery , Reoperation , Sella Turcica/abnormalities , Sella Turcica/surgery , Tomography, X-Ray ComputedABSTRACT
Here we report the case of a 19-year-old somalian man who has been admitted to our emergency department because of an important lumbago without trauma. The physical examination on arrival showed a diffuse painful percussion of the left paraspinal muscles without neurological impairment. The laboratory exams displayed a significant elevation of the inflammatory response (CRP 154 mg/l, procalcitonin 0,05 µg/l), the blood cultures were negative and a thoracic and lumbar computed tomography (CT) was not conclusive. The unclear clinical picture led to a magnetic resonance imaging, showing the presence of an abscess in the left thoraco-lumbar paraspinal musculature with ongoing invasion of the epidural space. The clinical picture became dramatic as the patient suddenly developed a frank nuchal rigidity associated with an acute confusional state, caused by the rupture of the abscess in the meningeal space with secondary meningitis, confirmed by a lumbar puncture, where S. aureus was found.
Subject(s)
Emigrants and Immigrants , Epidural Abscess/diagnosis , Low Back Pain/etiology , Lumbar Vertebrae , Paraspinal Muscles , Staphylococcal Infections/diagnosis , Thoracic Vertebrae , Diagnosis, Differential , Emergency Service, Hospital , Epidural Abscess/surgery , Humans , Inflammation Mediators/blood , Low Back Pain/surgery , Lumbar Vertebrae/surgery , Male , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/surgery , Neurologic Examination , Paraspinal Muscles/surgery , Rupture, Spontaneous , Somalia/ethnology , Staphylococcal Infections/surgery , Switzerland , Thoracic Vertebrae/surgery , Tomography, X-Ray Computed , Young AdultABSTRACT
We report on two cases of spontaneous CSF otorrhea, which were considered to have been caused by enlarged arachnoid granulation with bone erosion of the posterior fossa. Both cases visited us complaining of severe headache, due to bacterial meningitis. In the first patient, a 68-year-old male, a high resolution CT scan showed a bony defect in the posterior fossa plate in the right temporal bone, where CSF leakage was confirmed during the operation. In the second patient, a 54-year-old female, a bony defect was located in the posterior fossa in the left temporal bone. In both cases, the bony defects were repaired by occlusion with the pedicled temporal muscles after the meningitis had been treated. CSF otorrhea disappeared after the surgery, and has not recurred during the postoperative observation period of 1 to 3 years.
Subject(s)
Cerebrospinal Fluid Otorrhea/surgery , Meningitis, Bacterial/surgery , Aged , Arachnoid/pathology , Cerebrospinal Fluid Otorrhea/etiology , Female , Humans , Male , Meningitis, Bacterial/complications , Middle Aged , Temporal Bone/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: Multidrug-resistant strains of Acinetobacter pose a serious therapeutic dilemma in hospital practice, particularly when they cause meningitis, as the few antimicrobial agents to which these isolates are susceptible have poor central nervous system (CNS) penetration. METHODOLOGY: We retrospectively reviewed the clinical course and outcome of eight consecutive cases of meningitis due to Acinetobacter spp. in children ages 15 years or less, seen in a tertiary care medical center in Karachi, Pakistan. RESULTS: Of the eight cases of Acinetobacter meningitis, isolates from five patients were pan-resistant, and two were multidrug-resistant. A neurosurgical procedure was performed in five of eight patients followed by external ventricular drain insertion prior to the development of infection. Seven received intravenous (IV) polymyxin (mean; 12.8 days), while 5/8 also received intrathecal (IT) polymyxin (mean; 12.0 days). The mean length of hospitalization was 38.7 ± 19 days. All patients achieved cerebrospinal fluid (CSF) culture negativity by the end of treatment (mean; 5.4 days). Two patients died: one with pan-resistant Acinetobacter, and the second with a multi-drug resistant isolate. CONCLUSION: Post-neurosurgical multidrug-resistant and pan-resistant Acinetobacter meningitis can be successfully treated if appropriate antimicrobial therapy is instituted early. The role of IT polymyxin B administration alone versus combination therapy (IV and IT) needs further study.
Subject(s)
Acinetobacter Infections/diagnosis , Acinetobacter Infections/pathology , Acinetobacter/isolation & purification , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/pathology , Acinetobacter/drug effects , Acinetobacter Infections/drug therapy , Acinetobacter Infections/surgery , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Child , Drainage/adverse effects , Drug Resistance, Multiple, Bacterial , Female , Humans , Infant , Infant, Newborn , Length of Stay , Male , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/surgery , Pakistan , Polymyxins/therapeutic use , Postoperative Complications , Retrospective Studies , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: The anterior sacral meningocele is a rare form of spinal dysraphism located in the presacral extraperitoneal space. It is generally asymptomatic and appears as a small pelvic mass. CASE DESCRIPTION: We present a case of a 10 year-old male that develops a bacteria meningitis because of a pararectal abscess that is connected with an anterior sacral meningocele. We successfully treated it using a posterior approach. CONCLUSION: The aim of the surgery is to repair the dural defect and to obliterate the communication between the thecal sac and the herniation defect. The posterior approach is the simplest and most effective surgical technique because the lower risk of neurological injury than the anterior approach.
Subject(s)
Abnormalities, Multiple/microbiology , Abnormalities, Multiple/pathology , Meningocele/microbiology , Meningocele/pathology , Abnormalities, Multiple/surgery , Child , Humans , Magnetic Resonance Imaging , Male , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/physiopathology , Meningitis, Bacterial/surgery , Meningocele/surgery , Sacrococcygeal Region/abnormalities , Sacrococcygeal Region/microbiology , Sacrococcygeal Region/pathology , Sacrococcygeal Region/surgeryABSTRACT
OBJECT: Extraaxial infections of the CNS, including subdural empyema and epidural abscess, are rare but potentially life-threatening conditions. Symptoms are usually progressive, and early diagnosis is therefore important. Early intervention with appropriate treatment offers the best opportunity for eradicating the infection and promoting maximal neurological recovery. METHODS: The medical records of children with extraaxial CNS infection over the last 24 years at the Hospital for Sick Children were analyzed. Only those patients with radiological and/or operative confirmation of the diagnosis of subdural empyema or epidural abscess were included in the study. Demographic and clinical data were collected to determine the outcomes after such infections and factors that predict for such outcomes. RESULTS: The authors identified 70 children who fulfilled the inclusion criteria. Sinusitis was the most common etiology and was seen in 38 patients. All of these patients were older than 7 years of age at diagnosis. Subdural empyemas were diagnosed in 13 patients following bacterial meningitis, and they were found primarily in infants within the 1st year of life. Other etiological factors included otogenic infection (4 cases), postneurosurgical infection (7 cases), and hematogenous spread of infection (7 cases including 6 cases of spinal epidural abscess). Streptococcus anginosus and Staphylococcus aureus were the most common pathogens identified. Sixty-four patients (91.4%) underwent at least 1 neurosurgical procedure. Seizures and cerebral edema from cortical vein thrombosis were the most common complications. CONCLUSIONS: Due to variable etiology, identification of the responsible microorganism through neurosurgical drainage followed by long-term intravenous antibiotics remains the mainstay in treating extraaxial CNS infections. Optimal outcome is achieved with early diagnosis and therapy.