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1.
Medicine (Baltimore) ; 98(46): e17670, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725609

RESUMO

This study aims to identify predictive factors related to clinical outcome, reoperation, and complications in patients with brain abscess.Patients with a diagnosis of brain abscess at discharge at the Second Affiliated Hospital of Zhejiang University School of Medicine between 2008 and 2018 were reviewed. Logistic regression was used to identify predictive factors associated with Glasgow Outcome Scale (GOS) at discharge, GOS at 1 year after discharge, reoperation and complications.Among 183 patients enrolled into the study, 142 patients had a good outcome at discharge (GOS ≥ 4) and 41 had a poor outcome (GOS ≤ 3). During the follow-up period, 20 additional patients had a good outcome. A total of 156 patients were treated by open craniotomy excision (n = 72) and aspiration (n = 84), 10 of whom underwent reoperation. Complications in surgical patients for brain abscess occurred in 54 patients. Poor outcome was related to Glasgow coma scale (P = .007) and ventricular proximity (P = .001). Surgical method was associated with reoperation (P = .04) and complications (P < .001). Seizure at admission was related to epilepsy (P < .001). Surgical method was related to postoperative intracranial hemorrhage (P = .02).Glasgow coma scale (GCS) and ventricular proximity were associated with poor outcome. Further, patients who underwent aspiration were more likely to experience reoperation, while open craniotomy excision (OCE) was related to complications. Patients presenting seizure at admission were more likely to develop epilepsy. Patients who underwent OCE tended to experience postoperative intracranial hemorrhage.


Assuntos
Abscesso Encefálico/cirurgia , Escala de Resultado de Glasgow , Hemorragias Intracranianas/etiologia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/patologia , Criança , Pré-Escolar , Craniotomia/efeitos adversos , Craniotomia/métodos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
2.
BMC Infect Dis ; 19(1): 863, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638913

RESUMO

BACKGROUND: Invasive meningococcal disease (IMD) presenting with meningitis causes significant mortality and morbidity. Suppurative complications of serogroup B meningococcal sepsis are rare and necessitate urgent multidisciplinary management to mitigate long-term morbidity or mortality. CASE PRESENTATION: We present a rare case of invasive meningococcal disease in a 28-month old boy complicated by multiple abscess formation within a pre-existing antenatal left middle cerebral artery territory infarct. Past history was also notable for cerebral palsy with right hemiplegia, global developmental delay and West syndrome (infantile spasms). Two craniotomies were performed to achieve source control and prolonged antimicrobial therapy was necessary. The patient was successfully discharged following extensive multidisciplinary rehabilitation. CONCLUSIONS: Longstanding areas of encephalomalacia in the left MCA distribution may have facilitated the development of multiple meningococcal serogroup B abscess cavities in the posterior left frontal, left parietal and left temporal lobes following an initial period of cerebritis and meningitis. A combination of chronic cerebral hypoperfusion and some degree of pre-existing necrosis in these areas, may also have facilitated growth of Neisseria meningitidis, leading ultimately to extensive cerebral abscess formation following haematogenous seeding during meningococcemia. In this case report we review similar cases of cerebral abscess or subdural empyema complicating serogroup B meningococcal meningitis.


Assuntos
Abscesso Encefálico/microbiologia , Meningite Meningocócica/complicações , Neisseria meningitidis Sorogrupo B/genética , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Infarto Cerebral/complicações , Paralisia Cerebral/complicações , Pré-Escolar , Craniotomia , Empiema Subdural/tratamento farmacológico , Empiema Subdural/microbiologia , Seguimentos , Hemiplegia/complicações , Humanos , Masculino , Meningite Meningocócica/prevenção & controle , Reação em Cadeia da Polimerase , Sepse/tratamento farmacológico , Sepse/microbiologia , Resultado do Tratamento , Vacinação
3.
World Neurosurg ; 132: 29-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450002

RESUMO

BACKGROUND: The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses. CASE DESCRIPTION: A 68-year-old man presented with seizures after being treated for an unruptured bAVM using Squid (Emboflu), an NALEA. Radiologic imaging revealed brain lesions suspicious of abscesses around the previously treated bAVM. A surgical excision of the bAVM and the embolized material was performed as was drainage of the brain abscesses. Bacterial cultures were positive for Enterococcus faecalis, and the patient left the hospital with an appropriate antibiotic regimen without new deficits. CONCLUSIONS: This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Embolização Terapêutica , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Idoso , Abscesso Encefálico/cirurgia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirurgia
4.
World Neurosurg ; 130: 133-137, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295595

RESUMO

BACKGROUND: Eisenmenger syndrome is a rare sequela of uncorrected congenital heart disease complicated by pulmonary hypertension, from which reversal of the pathologic left-to-right cardiovascular shunt and cyanosis follow. Right-to-left shunting can lead to paradoxical cerebral emboli-increasing the risk of spontaneous or iatrogenic stroke and cerebral abscess. CASE DESCRIPTION: A 38-year-old man presented with new focal seizures due to a brain abscess. Ventricular septal defect and pulmonary hypertension were identified. Despite dexamethasone and broad-spectrum antibiotics, he developed hemiparesis and altered mental status and required emergent stereotactic abscess drainage. Despite the anesthetic hazards of Eisenmenger syndrome, the procedure was successful and the patient recovered completely. CONCLUSIONS: Noncardiac perioperative mortality in Eisenmenger syndrome is historically reported up to 19%, and risks are further increased with prolonged case duration or hypotension, mandating vigilant attention to volume status. Correspondingly, shorter- or lower-risk procedures such as stereotactic drainage are recommended. Procedures should be performed only at centers with expertise in management of Eisenmenger syndrome and cardiac-specialized anesthesiologists whenever possible. Although a conservative approach with early, aggressive medical management is preferred, operative intervention may be required in the setting of progressive deterioration and excellent postoperative outcomes are achievable.


Assuntos
Complexo de Eisenmenger/cirurgia , Cardiopatias Congênitas/cirurgia , Hipertensão Pulmonar/cirurgia , Hipotensão/cirurgia , Adulto , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Complexo de Eisenmenger/complicações , Cardiopatias Congênitas/complicações , Comunicação Interventricular/complicações , Comunicação Interventricular/cirurgia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipotensão/complicações , Hipotensão/diagnóstico , Masculino , Procedimentos Neurocirúrgicos
5.
Pediatr Neurosurg ; 54(3): 207-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238324

RESUMO

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.


Assuntos
Abscesso Encefálico/cirurgia , Candida , Candidíase/tratamento farmacológico , Fluconazol/uso terapêutico , Hidrocefalia/complicações , Encéfalo , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Derivação Ventriculoperitoneal/efeitos adversos
6.
World Neurosurg ; 129: 188-189, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31176834

RESUMO

Tuberculous brain abscess is an extremely rare form of central nervous system tuberculosis. This lesion usually occurs in the supratentorial space. Cerebellar tubercular abscesses are rare. Most of these cases occur in immunocompromised patients. We report an immunocompetent individual with tuberculous abscess of the cerebellum and discuss the role of stereotactic aspiration in the management of these rare lesions.


Assuntos
Abscesso Encefálico/cirurgia , Doenças Cerebelares/cirurgia , Paracentese/métodos , Técnicas Estereotáxicas , Tuberculose do Sistema Nervoso Central/cirurgia , Abscesso Encefálico/microbiologia , Doenças Cerebelares/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade
7.
J Mycol Med ; 29(2): 180-184, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056403

RESUMO

Emergence of saprophytic fungi thriving in dead plant material and soil as opportunistic human pathogens is of great concern. Cladosporium species are environmental saprophytes reported to cause various superficial and invasive fungal infections worldwide. C. sphaerospermum, a predominantly indoor fungus has been reported from cases of meningitis, subcutaneous and pulmonary fungal infections in the past. Herein we report the first case of cerebral abscess due to C. sphaerospermum in an immunocompetent host who was successfully managed by combined medical and surgical therapy.


Assuntos
Abscesso Encefálico/microbiologia , Cladosporium/isolamento & purificação , Cladosporium/patogenicidade , Micoses/diagnóstico , Adulto , Antifúngicos/farmacologia , Encéfalo/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Humanos , Imunocompetência , Imagem por Ressonância Magnética , Masculino , Micoses/tratamento farmacológico , Resultado do Tratamento
8.
J Clin Neurosci ; 66: 277-279, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31097380

RESUMO

A 72-year-old man without obvious risk factors initially presented with acute ischemic stroke and fever, without concomitant infection. Broad spectrum antibiotic therapy was initiated. Transthoracic and Transesophageal echocardiography, and cardiac MRI revealed a 20 mm round mass attached to the anterior mitral valve leaflet, suggesting the diagnosis of a benign cardiac tumor or a vegetation. At the site of infarction an abscess of 11 mm in diameter developed 30 days later. The patient underwent surgical valve repair for the prevention of further embolic complications. Histology revealed a cardiac papillary fibroelastoma (PFE). He made complete clinical recovery. Secondary abscess formation after ischemic stroke is rare: 11 other cases have been reported. Because they develop at the site of a previous ischemic infarct, these abscesses usually do not manifest by additional neurologic deficits, making difficult their diagnosis. In most cases a concomitant infection cannot be individualized. Even if these abscesses are a rare entity, patients with cerebral infarct presenting with fever must be closely follow-up with cerebral imaging. Even if PFE is a rare cardiac source of embolic stroke, it should be considered in the differential diagnosis of stroke in a patient where an alternative etiology has not been established.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Diagnóstico Diferencial , Fibroma/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/cirurgia , Masculino , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/cirurgia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia
9.
Br J Neurosurg ; 33(5): 550-554, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31131639

RESUMO

Introduction: Brain parenchymal abscesses are relatively infrequent but potentially serious infections in the paediatric population. Surgical intervention in addition to a prolonged administration of antibiotics is generally appropriate management. This study presents our centre's experience of managing such patients in the context of relevant literature. Method: A single-centre retrospective case note review was conducted over a 15 year period (2003-2017). Patients were selected from electronic hospital records using ICD10 code G06.0. Patients < 18 years of age with a confirmed intra-parenchymal abscess were included. Patient records were reviewed for abscess location, microbiology results, surgical intervention, and outcome using the Glasgow Outcome Score at 3 months. Results: Twenty-four patients were identified (mean age: 7.4 ± 5.3 years, male n = 11). Twelve (50.0%) patients had an abscess in the frontal lobe and Streptococcus was the most common causative microorganism (n = 15). Nineteen patients (79.2%) had an identifiable source which included: ENT infections, congenital cardiac malformations, recent dental surgery and meningitis. All 24 patients underwent surgery with 20 patients having a total of 32 aspirations between them and the other 4 having craniotomy and excision. Twenty patients had 3 month follow-up data of which 18 patients scored GOS: 5, one was GOS: 4 and one was GOS: 3. Conclusions: Brain parenchymal abscess remains an uncommon pathology in the paediatric population. The majority of patients have a preceding infection with Streptococcus as the most common causative organism. Antimicrobial therapy should be selected accordingly. All of our patients underwent surgical intervention and received intravenous antibiotics with favourable outcome and no mortality.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico/cirurgia , Craniotomia/métodos , Infecções Estreptocócicas/cirurgia , Abscesso Encefálico/tratamento farmacológico , Criança , Feminino , Humanos , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
11.
World Neurosurg ; 125: 175-178, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30743027

RESUMO

BACKGROUND: At present, the differential diagnosis of magnetic resonance imaging enhancing lesions can still be challenging. Preoperative imaging is a valuable tool characterized by high informative value, even if false-positive and false-negative results are possible. In this context, 5-aminolevulenic acid (5-ALA) represents a significant adjunct in glioblastoma (GBM) surgery displaying an assumed specific accumulation only in tumor cells. However, it was anecdotally reported that in some cases it can also be detected in nonneoplastic lesions mimicking GBM, thus potentially leading to misdiagnosis. Moreover, precise identification of involved pathogens from intraoperative brain samples may remain difficult. We report the case of an abscess from Aggregatibacter mimicking a GBM both during preoperative imaging and intraoperatively, since showing 5-ALA fluorescence. CASE DESCRIPTION: A 54-year-old man presented with intense cephalalgia, vomiting, and scotomas in his left eye. Brain magnetic resonance imaging demonstrated a right temporo-occipital rim-enhancing mass, highly suggestive of a GBM, and for this reason the patient underwent 5-ALA-guided complete removal. Histopathologic analysis proved the lesion to be a bacterial abscess from Aggregatibacter as confirmed by polymerase chain reaction on bacterial deoxyribonucleic acid. CONCLUSIONS: 5-ALA fluorescence may not be specifically involved only in malignant tumor cells, thus raising the suspect for alternative diagnoses to GBM and inviting caution into fluorescence-guided surgery.


Assuntos
Ácido Aminolevulínico , Abscesso Encefálico/diagnóstico por imagem , Infecções por Bactérias Gram-Negativas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Cirurgia Assistida por Computador/métodos , Aggregatibacter , Abscesso Encefálico/cirurgia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Glioblastoma/diagnóstico , Infecções por Bactérias Gram-Negativas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
12.
World Neurosurg ; 125: 327-328, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771547

RESUMO

Penetrating brain injury is 1 type of traumatic brain injury. Brain abscess is a common complication after penetrating brain injury, and fragments increase the risk of occurrence of brain abscess. It is uncommon to see the migration of bone fragments in the brain in clinical cases. We report a rare case of brain abscess with migration of bone fragments after traumatic brain injury.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Acidentes de Trânsito , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Seguimentos , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia
14.
Folia Microbiol (Praha) ; 64(3): 383-388, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30368648

RESUMO

Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 µg/mL) and resistance to amphotericin B (MIC = 4 µg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.


Assuntos
Ascomicetos/isolamento & purificação , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Micoses/diagnóstico , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Ascomicetos/efeitos dos fármacos , Ascomicetos/genética , Abscesso Encefálico/diagnóstico por imagem , República Tcheca , DNA Ribossômico/genética , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Resultado do Tratamento
15.
Intern Med ; 58(4): 581-583, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30210128

RESUMO

Foix-Chavany-Marie syndrome (FCMS) is a rare cortical type of pseudobulbar palsy characterized by the loss of voluntary control of the facial, pharyngeal, lingual, and masticatory muscles with preserved reflexive and autonomic functions. FCMS is generally associated with cerebrovascular diseases affecting the bilateral opercular regions. We herein report the clinical features of an 84-year-old right-handed Japanese man with FCMS due to a unilateral brain abscess. The patient's symptoms were resolved after treating the brain abscess. The present clinical results suggest that a unilateral brain abscess in the temporal operculum with a persistent old lesion in the contralateral insular cortex can induce FCMS.


Assuntos
Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Disartria/etiologia , Disartria/terapia , Paralisia Facial/etiologia , Paralisia Facial/terapia , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Disartria/diagnóstico , Disartria/fisiopatologia , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Lateralidade Funcional , Humanos , Masculino , Resultado do Tratamento
16.
Eur Ann Otorhinolaryngol Head Neck Dis ; 135(6): 457-459, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30337240

RESUMO

INTRODUCTION: Intracranial complications of acute rhinosinusitis are rare, but may turn life-threatening. CASE SUMMARY: We report a healthy 30-year-old male who complained of frontal headache, which developed while on a plane. A brain CT showed a low-density lesion on the left frontal convexity with right maxillary and ethmoid sinusitis. Despite receiving intravenous antibiotics, a follow-up brain CT showed two lesions with adjacent dural and leptomeningeal enhancement. A paranasal sinus CT revealed aggravated left frontal sinusitis and right maxillary sinusitis. The patient underwent craniotomy and brain abscess removal along with endoscopic sinus surgery. Seventeen days after the surgery, the patient was discharged with no neurological sequelae. CONCLUSION: To the best of our knowledge, this case is the first report regarding the association between barotrauma and intracranial complications of acute rhinosinusitis. A high index of suspicion and well-timed surgical evacuation may ensure a full recovery.


Assuntos
Barotrauma/complicações , Empiema Subdural/diagnóstico por imagem , Sinusite Etmoidal/diagnóstico por imagem , Sinusite Maxilar/diagnóstico por imagem , Meningite/etiologia , Rinite/diagnóstico por imagem , Doença Aguda , Adulto , Viagem Aérea , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Craniotomia , Empiema Subdural/etiologia , Empiema Subdural/cirurgia , Endoscopia , Sinusite Etmoidal/etiologia , Sinusite Etmoidal/cirurgia , Humanos , Imunocompetência , Masculino , Sinusite Maxilar/etiologia , Sinusite Maxilar/cirurgia , Meningite/cirurgia , Rinite/etiologia , Rinite/cirurgia , Tomografia Computadorizada por Raios X
17.
World Neurosurg ; 120: 200-204, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30170147

RESUMO

BACKGROUND: Syndrome of the trephined is a unique neurosurgical condition that is seen in patients that have undergone craniectomy. While the symptoms of the condition range from mild to severe, the only definitive treatment for the condition is replacement of the bone flap. This article presents a novel, temporary treatment for syndrome of the trephined in a patient with severe symptoms who was unable to undergo immediate cranioplasty due to infection. CASE DESCRIPTION: A 25-year-old gentleman with a history of trauma resulting in hydrocephalus, craniectomy, and eventually ventriculoperitoneal shunt placement presented with a cranial wound infection requiring removal of his bone flap. While being treated with antibiotics, with his bone flap removed, he developed severe syndrome of the trephined. An emergency bedside procedure was developed and executed to treat his condition. CONCLUSIONS: Treating syndrome of the trephined with an external suction device proved useful and lifesaving fort the patient presented. Such a device can be made with common supplies found within any hospital. The technique used to treat the patient is novel and may be useful for others to consider if ever faced with a similar situation.


Assuntos
Edema Encefálico/cirurgia , Lesões Encefálicas/cirurgia , Craniotomia/efeitos adversos , Hematoma Subdural/cirurgia , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Complicações Pós-Operatórias/cirurgia , Trepanação/efeitos adversos , Adulto , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/cirurgia , Edema Encefálico/diagnóstico por imagem , Lesões Encefálicas/diagnóstico por imagem , Moldes Cirúrgicos , Emergências , Hematoma Subdural/diagnóstico por imagem , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação/métodos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/cirurgia , Síndrome , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/efeitos adversos
18.
J Coll Physicians Surg Pak ; 28(9): S181-S183, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30173691

RESUMO

Streptococcus pluranimalium, a gram-positive aerobic coccus, has been isolated primarily from several farm animals. The pathogenicity of this species is not well characterised either in animals or humans. As per the literature, cases of S. pluranimalium infection in humans have been reported only a handful of times. We report the case of cerebral abscess caused by S. pluranimalium in a patient who presented with weakness and confusion. The diagnosis of cerebral abscess was made on imaging supported by microbiological culture. Burr hole procedure for abscess drainage followed by an antibiotic regimen based on culture and sensitivity results contributed to a successful outcome. The bacteria were identified by analytical profile index for Streptococci (API Strep) and VITEK 2 gram-positive cocci panel. The case was successfully treated with vancomycin.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Testes de Sensibilidade Microbiana/métodos , Infecções Estreptocócicas/microbiologia , Streptococcus/classificação , Streptococcus/isolamento & purificação , Animais , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estreptocócicas/complicações , Streptococcus/efeitos dos fármacos , Resultado do Tratamento
19.
Acta Neurochir (Wien) ; 160(10): 2055-2062, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30069602

RESUMO

BACKGROUND: Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions. METHODS: We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes. RESULTS: The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%. CONCLUSION: One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.


Assuntos
Abscesso Encefálico/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Feminino , Infecção Focal Dentária/complicações , Humanos , Masculino , Mastoidite/complicações , Pessoa de Meia-Idade , Sinusite/complicações
20.
J Clin Neurosci ; 55: 93-96, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29980473

RESUMO

BACKGROUND AND IMPORTANCE: Intracerebral abscess is a very serious condition associated with significant morbidity and mortality. This article describes a novel treatment for a cerebral abscess, using the Penumbra Apollo suction/vibration aspiration system (Penumbra, Almeda, CA, USA). This article represents the first reported case of the device's use for treatment of an intracerebral abscess. CLINICAL PRESENTATION: The patient discussed presented to the emergency department in critical condition, and was found to be suffering from a right thalamic cerebral abscess. She underwent treatment with both medical management and surgical intervention with the use of the Apollo system. CONCLUSION: This report details a novel technique for surgical abscess drainage with an excellent clinical outcome. The aim is to provide insight into the treatment of intracerebral abscesses, the utility of the Apollo system, and the device's application beyond intracerebral and intraventricular hemorrhage.


Assuntos
Abscesso Encefálico/cirurgia , Sucção/instrumentação , Adulto , Feminino , Humanos , Resultado do Tratamento , Vibração
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