Abstract:Background: Brain abscess (BA) is an uncommon intracranial suppurative infectious disease, especially in children. Treatment involves surgery and prolonged courses of antibiotics. Objectives: Our study aimed to describe clinical characteristics of children with BA treated in middle Tunisian health centers. Methods: A retrospective study lasting 19 years (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) was conducted in Tunisia middle region. Forty one children having radiologic abnormalities suggestive of BA and confirmed per operative lesions were included. Mycobacterial, parasitic or fungal abscesses were excluded. Medical records were analyzed for age, gender, presenting symptoms, predisposing factors, imaging, microbiology results, treatment and outcome. Results: The mean age was 4.9 years. The most common clinical presentations were intracranial hypertension symptoms (87%). BA was diagnosed in 95.1% on the basis of cranial imaging. The majority of abscesses was supra-tentorial (92.6%). The most frequent etiology was loco-regional infections (63.4%). No predisposing factor was found in 17%. Intravenous antibiotics were given in all cases with surgical drainage in 63.4%,. Causative organisms were identified in 53.7%. The mortality rate was 24.3%. Age less than 2 years was the only statistically significant prognostic factor identified. Conclusion: Our study confirmed the severity of this pathology and underlined the importance of early diagnosis and management.

Background: Brain Abscess (BA) is an uncommon intracranial suppurative infectious disease, especially in children. Its treatment involves surgery and prolonged antibiotics courses. Objectives: The current study aimed at describing the clinical characteristics of children with BA, treated at the central Tunisian region health center. Methods: A retrospective study, lasting 19 years (1995 to 2014), was conducted in four Tunisia pediatric departments of the central region. Forty-one children having radiological abnormalities suggestive of BA and confirmed operative lesions were included. Mycobacterial, parasitic or fungal abscesses were excluded. Medical records were analyzed for age, gender, presenting symptoms, predisposing factors, imaging, microbiology findings, treatment, and outcome. Results: The mean age was 4.9 years (range: 4 days to 16 years). The most common clinical presentations were increased intracranial pressure symptoms (87%). Brain Abscess was diagnosed in 95.1% on the basis of cranial imaging. The majority of abscesses were supratentorial (92.6%). The most frequent etiology was contiguous infections of the skull (63.4%). No predisposing factor was found in 17%. Intravenous antibiotics were given in all cases with surgical drainage in 63.4%, causative organisms were identified in 53.7%; gram positive cocci in 21.9%, and gram negative cocci in 9.7%. The mortality rate was 24.3%. Age of less than two years was the only statistically significant identified prognostic factor. Conclusions: The current study confirmed the severity of this pathology and underlined the importance of early diagnosis and management.

Pilomyxoid astrocytomas (PMA) is a particular form of glial tumors distinct from pilocytic astrocytomas (PA). On the last 2016 WHO classification for CNS tumours, no definite grade assignment was proposed for these lesions. They may be more aggressive with a different clinical course compared to PA due to their greater propensity for local recurrence and cerebrospinal dissemination. Most cases arise from the hypothalamic region. Only few studies reported cerebellar localization of the lesion. We report 3 pediatric cases treated for pediatric PMA of the posterior fossa. Clinical, radiological, and prognostic features were reviewed. The age of our patients was between 1 and 9 years old. Signs of intracranial hypertension were found in all patients. One of them presented an increased head circumference and the 2 others had a cerebellar syndrome. Brain CT-scan and MRI displayed a large wellcircumscribed intra-axial solid and cystic posterior fossa tumor. Total surgical resection was performed for all tumors. After a 2 years follow up, no signs of recurrence were noticed. In the literature, PMA been reported with overwhelming majority in children aged between 2 months and 4 years. Despite of many pathological similarities with PAs, PMAs have some specific features in histology, leading to their identification as independent type of glioma. Radiological differential diagnosis between PMAs and Pas can be made using arterial spin labeling imaging, which shows low perfusion parameters in PAs. Clinical and radiological follow up are mandatory do to different natural history and higher rates of local recurrence of this tumor compared to PA. Prognosis is favorable when complete surgical exeresis is possible.

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