Oral sequential therapy in the treatment of post-surgical epidural abscess and subdural empyema.

PURPOSE: The management of post-surgical subdural empyema and subdural abscess is not standardised. The objective was to analyse the efficacy and safety of oral sequential therapy (OST). METHODS: Retrospective observational study in a tertiary hospital in Vigo (Spain). We included adult patients with subdural abscess or epidural empyema with microbiological isolation. Clinical and demographic variables, isolated microorganisms and treatment regimens were included, as well as mortality and adverse effects during the follow-up period. RESULTS: Thirty patients were reviewed, two died due to causes other than infection. Six-month recurrence rate was 2/28 and all other patients (26/28) had clinical cure at the end of the treatment. The commonest isolated microorganisms were Gram-positive, especially Staphylococcus aureus. The most widely used oral antibiotic was trimethoprim-sulfamethoxazole (80%). No side effects related to oral treatment were observed. CONCLUSION: After adequate source control, OST can be a safe practice in the management of post-surgical epidural abscess and subdural empyema.

Persistent extra-axial post-surgical collections and Propionibacterium acnes infection. Presentation of two cases and literature review. / Colecciones posquirúrgicas extraaxiales persistentes e infección por Propionibacterium acnes. Presentación de dos casos y revisión de la literatura.

OBJECTIVES: It is common to observe the persistence of extra-axial collections after craniotomies. Most of these disappear in weeks or months but some remain. The onset of focal symptoms or the growth of these persistent collections months or years after surgery may indicate the presence of a chronic and latent infection by germs of low virulence such as Propionibacterium acnes (P. acnes). METHODS: We present two clinical cases with persistent extra-axial collections, which required surgery years after diagnosis, in which P. acnes was isolated as an aetiological agent and we reviewed the literature published in this regard. RESULTS: These are two patients who, following surgical procedures (decompressive craniectomy for severe TBI and craniotomy for right parietal meningioma) and extra-axial collections were kept, which were monitored over time and then were infected and required emergency evacuation. In these collections P. acnes grew as a causal agent and required targeted antibiotics. CONCLUSIONS: We must consider P. acnes as an infectious agent of post-surgical collections of long evolution. Atypical presentation and radiological changes may be helpful in diagnosis.

Colecciones posquirúrgicas extraaxiales persistentes e infección por Propionibacterium acnes. Presentación de dos casos y revisión de la literatura / Persistent extra-axial post-surgical collections and Propionibacterium acnes infection. Presentation of two cases and literature review

Objetivos: Es frecuente observar la persistencia de colecciones extraaxiales tras craneotomías. La mayoría de estas, desaparecen en semanas o meses pero algunas perduran. La aparición de clínica focal o el crecimiento de estas colecciones persistentes meses o años después de la cirugía pueden indicar la presencia de una infección crónica y latente por gérmenes de baja virulencia como Propionibacterium acnes (P. acnes). Métodos: Presentamos dos casos clínicos con colecciones extraaxiales persistentes, que precisaron cirugía, años después de su diagnóstico, en los que se aisló P. acnes como agente etiológico y revisamos la literatura publicada al respecto. Resultados: Se trata de dos pacientes que posterior a procedimientos quirúrgicos (craniectomía descompresiva por TCE grave y craneotomía por meningioma parietal derecho) desarrollaron colecciones extraaxiales que se mantuvieron vigiladas en el tiempo y que luego se infectaron y precisaron evacuación urgente de las mismas. En estas coleccionas creció el P. acnes como agente causal y precisó antibioterapia dirigida. Conclusiones: Debemos tomar en cuenta al P. acnes como agente infeccioso de colecciones posquirúrgicas de larga evolución. La presentación atípica y los cambios radiológicos pueden ser de ayuda en el diagnóstico

Objectives: It is common to observe the persistence of extra-axial collections after craniotomies. Most of these disappear in weeks or months but some remain. The onset of focal symptoms or the growth of these persistent collections months or years after surgery may indicate the presence of a chronic and latent infection by germs of low virulence such as Propionibacterium acnes (P. acnes). Methods: We present two clinical cases with persistent extra-axial collections, which required surgery years after diagnosis, in which P. acnes was isolated as an aetiological agent and we reviewed the literature published in this regard. Results: These are two patients who, following surgical procedures (decompressive craniectomy for severe TBI and craniotomy for right parietal meningioma) and extra-axial collections were kept, which were monitored over time and then were infected and required emergency evacuation. In these collections P. acnes grew as a causal agent and required targeted antibiotics. Conclusions: We must consider P. acnes as an infectious agent of post-surgical collections of long evolution. Atypical presentation and radiological changes may be helpful in diagnosis

MR imaging findings of neurosarcoidosis of the gasserian ganglion: an unusual presentation.

We report the MR imaging findings of an unusual case of neurosarcoidosis of the gasserian ganglion associated with trigeminal neuralgia. No other neurological or extraneurological localization was found. Magnetic resonance imaging demonstrated a mass in the Meckel's diverticulum that was isointense on T1-weighted images and hypointense on T2-weighted images. Gadolinium-enhanced MR imaging showed heterogeneous enhancement. Although rare, sarcoid infiltration of the gasserian ganglion must be considered in the differential diagnosis of an isolated mass in this localization in patients with trigeminal neuralgia.