1/146. brain abscess caused by streptococcus intermedius: two case reports.BACKGROUND: Although streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous system, the streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species. CASE DESCRIPTION: Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits. CONCLUSION: It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
2/146. brain abscess caused by salmonella enteritidis in an immunocompetent adult patient: successful treatment with cefotaxime and ciprofloxacin.A previously healthy 43-y-old man, who had spent 2 weeks in northern india, was admitted to hospital after a 2-day history of pyrexia, confusion and frontal headache. Cranial computerized tomography (CT) showed an abscess in the right parietal lobe. Spinal fluid and blood cultures gave growth of salmonella enteritidis within 24 h. Treatment with cefotaxime was initiated, but ceased after 3 weeks due to drug fever, and ciprofloxacin was then given orally for 4 months. After 6 months, the patient was considered cured. Cases of salmonella brain abscesses are reviewed.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
3/146. Postcraniotomy gas-containing brain abscess: a neurosurgical emergency. Case report.BACKGROUND: Gas-containing brain abscesses are very rare, and the majority are caused by clostridium perfringens. We report a case of gas-containing brain abscess that required urgent surgery after a craniotomy for a brain tumor. methods AND RESULTS: The patient was a 53-year-old male who presented with a cerebral neoplasm. A temporal lobectomy was performed and the diagnosis of low grade glioma was confirmed. Although the surgery was uneventful the postoperative course was complicated; the patient became agitated and febrile and deteriorated to a deep coma. A computed tomography scan demonstrated gas in the temporal fossa at the lobectomy site, producing mass effect. Urgent surgical debridement and drainage was performed and C. perfringens and mixed flora were found. Antibiotics were started and the patient's condition markedly improved. He was awake and alert, followed commands adequately and was extubated; however, after a week he suffered massive gastrointestinal bleeding and died. CONCLUSIONS: Early recognition of a gas-containing brain abscess is of great interest to immediately start the appropriate treatment. Urgent surgical debridement and broad spectrum chemotherapy are major components in the management of this entity.- - - - - - - - - - ranking = 2keywords = lobe (Clic here for more details about this article) |
4/146. Delayed intracranial abscess after acoustic neuroma surgery: a report of two cases.OBJECTIVE: The use of antibiotics before and after surgery has made infectious complications of neurotologic surgery rare. The neurosurgical literature cites a rate of postoperative meningitis between 1% and 2% for "clean" cases and 1.5% to 2.5% for "clean contaminated" cases, such as cerebrospinal fluid contact with the middle ear or mastoid. Reports of infections after neurotologic procedures are rare in the otologic literature. In this report, two patients with brain abscess occurring in a delayed fashion after surgery are described. STUDY DESIGN: The study design was a retrospective chart review and case report. SETTING: The study was conducted at a tertiary referral center. RESULTS: Patient 1 underwent a suboccipital craniotomy for removal of an acoustic neuroma and had an uneventful postoperative recovery. Three months after surgery, he reported mild unsteadiness. Examination revealed mild ataxia, which led to repeat magnetic resonance imaging (MRI) and a diagnosis of cerebellar abscess. Patient 2 underwent translabyrinthine removal of an acoustic neuroma complicated by postoperative pseudomonas aeruginosa meningitis, which responded promptly to intravenous antibiotics. Fifteen months after surgery, he visited a neurologist after having a seizure and was treated with anticonvulsants. After a second episode of seizure, imaging studies showed a temporal lobe abscess. CONCLUSIONS: The signs of intracranial abscess may be subtle and can occur weeks or months after surgery, requiring vigilance and a high index of suspicion for diagnosis. A change in postoperative symptoms after acoustic neuroma surgery should signal further investigation using MRI with gadolinium.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
5/146. magnetic resonance imaging and angiography in cerebral fungal vasculitis.We report on an 11-year old girl treated for leukemia who developed infarcts in the right lentiform nucleus and temporal lobe. magnetic resonance angiography (MRA) showed mild intraluminal irregularities in the right carotid syphon and stenosis of the right proximal middle cerebral artery, suggesting vasculitis. magnetic resonance imaging (MRI) follow-up showed evolution of the initial infarct into an abscess. Stereotactic biopsy disclosed filaments of aspergillus. This report emphasizes the fact that cerebral aspergillosis should be considered if MRA and MRI are indicative of vasculitis and cerebral infarction in immunosuppressed children.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
6/146. glioblastoma multiforme at the site of metal splinter injury: a coincidence? Case report.The authors report the case of a man who had suffered a penetrating metal splinter injury to the left frontal lobe at 18 years of age. Thirty-seven years later the patient developed a left-sided frontal tumor at the precise site of the meningocerebral scar and posttraumatic defect. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar and metal splinters. In addition, a chronic abscess from which propionibacterium acnes was isolated was found within the glioma tissue. The temporal and local association of metal splinter injury with chronic abscess, scar formation, and malignant glioma is highly suggestive of a causal relationship between trauma and the development of a malignant brain tumor.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
7/146. brain abscess in a patient with atrial septal defect.brain abscess rarely occurs in adults with congenital heart disease. A 59-year-old man who presented with headache, fever and stiffness of the neck was reported. The patient had a atrial septal defect with pulmonary hypertension and atrial fibrillation. CT scan of the brain demonstrated an abscess at the right parieto-occipital lobe. The patient was successfully treated with appropriate antibiotics.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
8/146. Pituitary abscess secondary to isolated sphenoid sinusitis.Intracranial complications from isolated sphenoid sinusitis are rare but nevertheless demonstrate both a high morbidity and mortality. We herein report a case of a pituitary abscess secondary to sphenoid sinusitis in a 12-year-old boy. This patient presented with an acute onset of moderate fever and headache, followed by progressive right ptosis. An emergency endoscopic endonasal sphenoidotomy with sinus drainage and postoperative antibiotic therapy resulted in a satisfactory recovery.- - - - - - - - - - ranking = 49.250681071505keywords = pituitary (Clic here for more details about this article) |
9/146. Multiple brain abscesses caused by salmonella typhi: case report.BACKGROUND: Focal intracranial infections caused by Salmonella species are uncommon. The authors report a case of multiple brain abscesses caused by salmonella typhi. CASE DESCRIPTION: A 2-month-old girl was admitted to the hospital because of diarrhea, vomiting, fever, and poor feeding. Neurological examination revealed cervical hyperextension and absence of sucking and Moro reflexes. During the next 20 hours she developed complex partial seizures with secondary generalization and alternated irritability with drowsiness. Investigation showed hemoglobin 6.3 g/dl; white blood cell count of 19500/mm3 with a marked shift to the left. The analysis of the cerebrospinal fluid revealed white cell count of 1695/mm3, lymphocytes 61%, protein 300 mg/dl and glucose 6 mg/dl. The patient was treated for acute gastroenterocolitis, sepsis, and meningitis. Blood culture taken on the day of admission showed gram-negative bacilli, later identified as S. typhi. Computed tomography scan demonstrated a lesion in the right parietal lobe compatible with a brain abscess. Follow-up computed tomography after 7 days showed several other lesions with the same features. Surgical drainage of the right parietal lesion was performed on the 13th day, through a burr hole. The patient was discharged 5 weeks after admission without neurological deficit. CONCLUSION: bacteremia, sepsis, and meningitis are relatively common in children with Salmonella infection but intracranial abscesses are very rare. Surgical drainage combined with prolonged antibiotic therapy (drug of choice: chloramphenicol) is the best treatment for Salmonella brain abscesses. The possibility of intracranial infection should be considered in patients with Salmonellosis and neurological dysfunction.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
10/146. Primary CNS lymphoma associated with streptococcal abscess: an autopsy case.This report describes a case of streptococcal abscess in the nodules of a primary central nervous system (CNS) lymphoma. magnetic resonance imaging (MRI) of the brain revealed multiple lesions with ringlike enhancement over the bilateral frontal, right temporal, and left parietal lobes. On admission, acute brain edema occurred following angiography, which resulted in respiratory arrest. autopsy findings showed that the ringlike enhanced lesions on MRI were streptococcal abscesses localized in the lymphoma nodules. The lymphoma was classified as non-Hodgkin, diffuse large cells of B-cell lineage. No other lymphoma mass was found extracranially. An immunohistochemical study showed that the lymphoma cells were positive for leukocyte common antigen, Epstein-Barr virus, bax. and bcl-XL, and negative for L-26 and bcl-2. This case demonstrated that an opportunistic streptococcal abscess developed in primary CNS lymphoma in a patient without acquired immunodeficiency syndrome (AIDS), though a few similar cases have been reported in patients with AIDS.- - - - - - - - - - ranking = 1keywords = lobe (Clic here for more details about this article) |
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