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Acta Clinica Croatica Dec 2018- A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had...
- A case of a 37-year-old female patient is presented. The patient was admitted to the Surgical Emergency Unit after accidental fall on a metal rod when she had sustained stab injury of the right orbit with penetration into the right frontal brain lobe. Multi-slice computed tomography (MSCT) showed penetrating injury and fracture of the right orbital roof without eyeball damage and endocranial impressed bone fragments into the right frontal brain lobe. Urgent surgical intervention was performed by a maxillofacial surgeon and neurosurgeon, including reposition of bone fragments of the orbital roof and cranioplasty. Reconstruction of Tenon's capsule of the right eyeball was performed by an ophthalmologist. From the intraoperative wound swab of the orbit, was isolated, therefore the patient was administered ciprofloxacin and rifampicin as recommended by an infectious disease (ID) specialist. Follow up brain MSCT at 15 days and magnetic resonance imaging of the brain at 25 days showed brain edema in the right frontal area and signs of local brain abscess. Intravenous administration of the ciprofloxacin and metronidazole antibiotics with corticosteroids for edema suppression were ordered by the ID physician. Fourteen weeks after this therapy, brain MSCT showed complete abscess regression and no neurologic deficit with only mild psychomotor changes.
Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Eye Injuries; Female; Fracture Fixation; Humans; Magnetic Resonance Imaging; Neurosurgical Procedures; Ophthalmologic Surgical Procedures; Orbit; Orbital Fractures; Postoperative Complications; Skull; Tomography, X-Ray Computed; Treatment Outcome; Wounds, Penetrating
PubMed: 31168221
DOI: 10.20471/acc.2018.57.04.26 -
BMJ Case Reports Jun 2017Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised...
Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.
Topics: Anti-Bacterial Agents; Antiprotozoal Agents; Brain Abscess; Ceftriaxone; Diagnosis, Differential; Humans; Hydrocortisone; Hypopituitarism; Magnetic Resonance Imaging; Male; Metronidazole; Pituitary Diseases; Pituitary Gland; Treatment Outcome; Vancomycin; Young Adult
PubMed: 28596198
DOI: 10.1136/bcr-2016-217912 -
International Journal of Infectious... Feb 2022Differences in management and outcomes of brain abscesses due to gram-positive (GPB) versus gram-negative bacteria (GNB) are not well defined. (Review)
Review
OBJECTIVES
Differences in management and outcomes of brain abscesses due to gram-positive (GPB) versus gram-negative bacteria (GNB) are not well defined.
METHODS
A retrospective review of adult patients with brain abscesses due to monomicrobial infection from 2009 through 2020 was performed.
RESULTS
A total 177 patients had a monomicrobial brain abscess; 143 (80.8%) caused by GPB and 34 (19.2%) by GNB. Patients with GNB had more history of head/neck surgery than those with GPB (58.8% vs 36.4%; P = 0.02). Pathogens in the GNB group included Pseudomonas aeruginosa (29.4%), Klebsiella spp (20.6%), and Enterobacter spp (20.6%). Pathogens in the GPB group included Staphylococcus aureus (32.2%) and Streptococcus spp (31.5%). Most patients had combined medical/surgical management (64.7% GNB vs 63.6% GPB). The median duration of antibiotic therapy was 42 days, and there was no significant difference in infection relapse or 3-month survival rate. Patients with GNB were more likely to have therapeutic failure than those with GPB (44.1% vs 22.4%; P = 0.01).
CONCLUSIONS
Compared with brain abscesses caused by GPB, those due to GNB were more likely to occur in patients who had undergone prior head and neck surgery . No statistically significant difference in outcomes was observed between the groups; however, patients with GNB had a higher therapeutic failure rate than those with GPB.
Topics: Adult; Anti-Bacterial Agents; Bacteremia; Brain Abscess; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Humans; Retrospective Studies
PubMed: 34902581
DOI: 10.1016/j.ijid.2021.12.322 -
Clinical Infectious Diseases : An... Sep 2022
Topics: Brain Abscess; Case-Control Studies; Dentists; Humans
PubMed: 34967903
DOI: 10.1093/cid/ciab1063 -
Swiss Dental Journal 2016Background Nonsurgical periodontal treatment implicates bacteraemia. In rare cases oral pathogens can be found associated with abscesses of brain or liver Case...
Background Nonsurgical periodontal treatment implicates bacteraemia. In rare cases oral pathogens can be found associated with abscesses of brain or liver Case Description A brain abscess was found in a patient after several periodontal treatments causing neurological seizures. In the drain masses of Fusobacterium nucleatum were found. An oral examination revealed a severe periodontally damaged dentition. The woman had been in a generally healthy condition before the event. After neurosurgical treatment and intravenous antibiotic therapy the patient fully recovered. In order to eradicate any possible focus of inflammation, several teeth had to be extracted. Clinical Implications This case report implicates that also patients without particular need for antibiotic prophylaxis can be at risk of developing a brain abscess caused by bacteraemia after periodontal treatments.
Topics: Brain Abscess; Combined Modality Therapy; Craniotomy; Dental Scaling; Diagnosis, Differential; Female; Fusobacterium Infections; Fusobacterium nucleatum; General Practice; Humans; Magnetic Resonance Imaging; Middle Aged; Periodontitis; Retreatment; Root Canal Therapy
PubMed: 27808349
DOI: No ID Found -
Revista Brasileira de Terapia Intensiva Mar 2020
Topics: Brain Abscess; Humans; Male; Middle Aged; Mouth Diseases
PubMed: 32401980
DOI: 10.5935/0103-507x.20200025 -
Revista Da Sociedade Brasileira de... 2022
Topics: Brain; Brain Abscess; Headache; Humans; Toxoplasma
PubMed: 35976337
DOI: 10.1590/0037-8682-0212-2022 -
American Journal of Respiratory and... Dec 2014Within the past decade, pulmonary arteriovenous malformations (PAVMs) have evolved from rare curiosities to not uncommon clinical states, with the latest estimates... (Review)
Review
Within the past decade, pulmonary arteriovenous malformations (PAVMs) have evolved from rare curiosities to not uncommon clinical states, with the latest estimates suggesting a prevalence of ~1 in 2,600. PAVMs provide anatomic right-to-left shunts, allowing systemic venous blood to bypass gas exchange and pulmonary capillary bed processing. Hypoxemia and enhanced ventilatory demands result, although both are usually asymptomatic. Paradoxical emboli lead to strokes and cerebral abscesses, and these commonly occur in individuals with previously undiagnosed PAVMs. PAVM hemorrhage is rare but is the main cause of maternal death in pregnancy. PAVM occlusion by embolization is the standard of care to reduce these risks. However, recent data demonstrate that currently recommended management protocols can result in levels of radiation exposure that would be classified as harmful. Recent publications also provide a better appreciation of the hematologic and cardiovascular demands required to maintain arterial oxygen content and oxygen consumption in hypoxemic patients, identify patient subgroups at higher risk of complications, and emphasize the proportion of radiologically visible PAVMs too small to treat by embolization. This review, therefore, outlines medical states that exacerbate the consequences of PAVMs. Chief among these is iron deficiency, which is commonly present due to concurrent hereditary hemorrhagic telangiectasia: iron deficiency impairs hypoxemia compensations by restricting erythropoiesis and increases the risk of ischemic strokes. Management of periodontal disease, dental interventions, pulmonary hypertension, and pregnancy also requires specific consideration in the setting of PAVMs. The review concludes by discussing to what extent previously recommended protocols may benefit from modification or revision.
Topics: Anemia, Iron-Deficiency; Arteriovenous Malformations; Brain Abscess; Diagnostic Imaging; Disease Progression; Embolization, Therapeutic; Female; Hemorrhage; Humans; Hypoxia; Maternal Death; Pregnancy; Prevalence; Pulmonary Artery; Pulmonary Veins; Standard of Care; Stroke
PubMed: 25420112
DOI: 10.1164/rccm.201407-1254CI -
BMC Infectious Diseases Dec 2021Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features...
BACKGROUND
Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcomes.
METHODS
We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed.
RESULTS
Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years, and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fifteen patients (26.31%) had comorbidities, of which diabetes mellitus was the most common. Positive intracranial purulent material cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114-32.407, p = 0.037).
CONCLUSIONS
Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive intracranial specimens' culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.
Topics: Brain Abscess; Comorbidity; Female; Humans; Klebsiella pneumoniae; Male; Odds Ratio; Retrospective Studies
PubMed: 34903183
DOI: 10.1186/s12879-021-06947-2 -
European Review For Medical and... Oct 2023Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment...
OBJECTIVE
Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment strategies are crucial for mitigating mortality risks in patients with brain abscesses. A nuanced understanding of potential microbial agents is pivotal for the development of empirical antibiotic therapies. This study aimed to explore the incidence and microbial etiology of brain abscesses.
PATIENTS AND METHODS
This study is a nationwide cross-sectional analysis of patients diagnosed with brain abscesses in Turkey, employing the ICD 10 diagnosis code from January 1, 2015, to December 31, 2021. Data pertaining to age, sex, comorbidities, and microorganisms isolated from central nervous system samples were meticulously recorded and analyzed.
RESULTS
This study included 11,536 patients diagnosed with brain abscesses. The incidence fluctuated between 0.98 and 3.68 during the review decrease post-2017, with a notable increase in male patients during time. Diabetes constituted 56.5% of the patients. The predominant isolated pathogens were Staphylococcus (37.6%), Streptococci (13.3%), and Klebsiella spp. (7.8%), Escherichia coli (6.4%), and Candida species (6.1%).
CONCLUSIONS
The incidence of brain abscesses is decreasing in Turkey. Although staphylococci remain the most isolated agents, the frequent occurrence of Gram-negative bacteria and Candida species warrants consideration during empirical antibiotic selection.
Topics: Humans; Male; Cross-Sectional Studies; Incidence; Turkey; Anti-Bacterial Agents; Staphylococcus; Brain Abscess; Microbial Sensitivity Tests; Retrospective Studies
PubMed: 37916333
DOI: 10.26355/eurrev_202310_34140