1/27. Intracerebral abscess caused by nocardia otitidiscaviarum in a renal transplant patient--cured by evacuation plus antibiotic therapy.We present a 50-year-old female who experienced generalized convulsion 3 months after a successful cadaveric renal transplantation. The first cerebral CT scan indicated cerebral frontal infarction. Repeat CT some days later revealed progressive lesions, and a highly malignant tumor or abscess was suspected. Antifungal and broad-spectrum antibacterial therapy was initiated. Cerebral MRI could not differentiate between these conditions, but a neutrophil granulocyte scan strongly suggested an infectious process. A stereotactic puncture of the frontal lobe was followed by temporary improvement. A severe progressive left-sided hemiparalysis gave indication for a craniotomy with evacuation of the abscess 9 days later. culture of aspirated pus yielded growth of a gram-positive, rod-shaped bacterium, later identified as nocardia otitidiscaviarum by sequencing the 16S rRNA. The patient was treated with meropenem plus rifampicin intravenously for 6 weeks followed by oral ciprofloxacin and rifampicin for 2 months. Due to pharmacokinetic interaction with rifampicin, the prednisolone dose was doubled, and the dose of tacrolimus had to be tripled for maintenance of adequate trough concentrations. Five months following cessation of antibiotic treatment, the patient has regained normal strength and function in her left-sided extremities and has a serum creatinine level of about 160 micromol/l (1.8 mg/dl).- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/27. Treatment of intracranial abscess in the era of neuroimaging: an analysis of 13 consecutive cases.We report a series of 13 consecutive patients with intracranial abscess treated at our institution since examination by computed tomography (CT) became available. After various treatments, all abscesses healed. CT has broadened the range of treatment options. Manual puncture was performed in most patients. Stereotactic aspiration through a burr hole, medical therapy alone, or complete excision, including the capsule, via craniotomy may be chosen in cases selected by CT analysis. Individualization of treatment in this disease has become increasingly valuable in effecting a cure.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/27. Intracranial vasculitis and multiple abscesses in a pregnant woman.Cerebral vasculitis is an unusual disorder with many causes. Infectious causes of cerebral vasculitis are predominantly bacterial or viral in nature. Purulent bacterial vasculitis is most often a complication of severe bacterial meningitis. The patient is a 25-year-old African American female, 25 weeks pregnant, who presented to the neurology service after a consult and referral from an outside hospital. She had a 1-month history of right sixth nerve palsy. Initial workup included a negative lumber puncture and a noninfused magnetic resonance imaging (MRI). Three days later, the patient developed right-sided migraine headaches and right third nerve palsy. The angiogram revealed diffuse irregularity and narrowing of the petrous, cavernous, and supraclinoid portions of the internal carotid and right middle cerebral arteries. Shortly thereafter, an MRI examination revealed diffuse leptomeningeal enhancement and abscess and a right parietal subdural empyema. Infectious vasculitis secondary to purulent meningitis has a rapidly progressive course and presents with cranial nerve palsy with involvement of the cavernous sinus. Although the association of this disease with pregnancy has not been established, it should be recognized that the early imaging studies may be negative or discordant and follow-up imaging might be necessary.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/27. brain abscess as a rare complication in a hemodialysed patient.BACKGROUND: Infections remain among the most common morbid events and are an important cause of death in end stage renal disease. They have reduced immune response and increased hazard of infections due to repeated puncture of an arterio-venous fistula, formation of haematoma at the site of cannulation and central vein catheterisation. CASE REPORT: We report a case of brain abscess in chronically haemodialysed patient admitted to our department due to haedache, vomiting, accelerated hypertension and fever. The clinical examination revealed narroving of the right palpebral slit, weeping and right oral angle hanging loose. He had mild microcytic anaemia and high level of g-globulin. Ophtalmologic examination showed normal oculi fundi. The computed tomography revealed heterogenous mass marginally enhanced with contrast agent in the right frontal cerebral lobe. The right fronto-temporal craniotomy was performed and the right frontal lobe abscess was found and totally excised. The postoperative course was uneventful besides of seizures which were effectively treated with carbamazepine. After bilateral nephrectomy the patient undervent succesfull kidney transplantation and is in good condition without any neurological defect. A probable cause of his brain abscess was peridontal abscess recognized 3 month earlier or bilateral vesicoureteral refluxes. CONCLUSIONS: 1. Uremic patients have a reduced immunocapacity and are a high risk group for infections of various etiology. 2. Prompt eradication of all sources of infection is essential in hemodialysed patients.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/27. Tuberculous brain abscess in a patient with AIDS: case report and literature review.Tuberculous brain abscesses in AIDS patients are considered rare with only eight cases reported in the literature. We describe the case of a 34-year-old woman with AIDS and previous toxoplasmic encephalitis who was admitted due to headache and seizures. A brain computed tomography scan disclosed a frontal hypodense lesion with a contrast ring enhancement. brain abscess was suspected and she underwent a lesion puncture through a trepanation. The material extracted was purulent and the acid-fast smear was markedly positive. Timely medical and surgical approaches allowed a good outcome. Tuberculous abscesses should be considered in the differential diagnosis of focal brain lesions in AIDS patients. Surgical excision or stereotactic aspiration, and antituberculous treatment are the mainstay in the management of these uncommon lesions.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/27. Intracerebral abscess after abutment change of a bone anchored hearing aid (BAHA).OBJECTIVE: Brain abscesses are life-threatening and sometimes difficult to detect. A brain abscess after placement, manipulation of a bone anchored hearing aid, or a periauricular implant for fixation of an ear prosthesis has never been reported in the literature. PATIENT: A 42-year-old man suffered from a right-sided temporodorsal brain abscess after change of a bone anchored hearing aid abutment. The fixture itself had been inserted 8 years before without any complications in the peri- or postoperative period. A CT-guided puncture of the abscess could be performed via the screw-hole in the temporal bone after removal of the fixture, and the patient was treated with antibiotics. RESULTS: The outcome of the procedure was good without neurologic deficits for the patient. CONCLUSION: The insertion of periauricular screw implants bears the risk of meningeal lesions as well as a small risk of purulent intracranial and intracerebral complications perioperatively or in the context of later manipulations. Minimally invasive therapy of such brain abscesses can be performed by removal of the foreign body, CT-guided puncture, and antibiotic medication.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
7/27. Long-term survival following treatment of multiple supra- and infratentorial aspergillus brain abscesses.aspergillus brain abscess is a rare but frequently fatal disease. Despite the scarcity of reported survivors, a combination of medication and surgical treatment might be effective. We report a 37-year-old man who developed multiple aspergillus brain abscesses after severe bacterial pneumonia. The following strategy was used to treat the patient: diagnostic puncture of one of the abscesses, long-term treatment with medication, excision of chronic granuloma in the occipital lobe and fourth ventricle, surgical treatment of the hydrocephalus. Following various surgical and antifungal treatments, the patient survived. Nearly three years after discharge, he still is in good physical condition and has a moderate neurologic deficit. Only 36 patients have been reported to have survived longer than three months after receiving treatment for brain aspergillosis. A course of medication in combination with various surgical procedures was required to achieve a successful outcome in this otherwise fatal disease.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/27. brain abscess after milk tooth self-extraction.Brain abscesses are rare, especially in children, but they can be life-threatening infections. To date, dental pathology has been linked to only a small number of brain abscesses. To our best knowledge this is the first reported case of a brain abscess following self-extraction of a milk tooth. We are reporting on a 12-year-old previously healthy boy who developed a brain abscess in the vicinity of the left precentral gyrus. Clinical examination prior to surgery showed a severe right hemiparesis, more pronounced in his leg. We performed an ultrasonographically guided puncture and aspiration of the abscess through a small craniotomy. Immediately after the procedure he became hemiplegic. Bacteriological examination of the aspirated pus revealed streptococcus intermedius, Streptococcus beta-haemolyticus group F, fusobacterium species and gram-negative rods. The same species of microorganisms were identified in a smear from the vicinity of the extracted tooth. The patient was carefully screened for possible other sources of infection, but none was found. Following appropriate antimicrobial treatment he recovered completely and returned home without any neurological deficit.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/27. brain abscess secondary to the middle ear cholesteatoma: a report of two cases.We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected. The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/27. Opening of the ventricular system--a potential peroperative complication of total brain abscess extirpation.Total extirpation of a brain abscess runs the risk of opening the ventricular system and of its contamination. Three case reports are described with this peroperative complication. All of them healed. Stress is laid on postoperative care calling for the application of antibiotics through lumbar puncture or directly into the cerebral ventricles.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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