An intra-cerebral abscess in a patient with Eisenmenger syndrome: An unusual case

Hall, Allan; White, Mark A.; Gallo, Pasquale

doi:10.1016/j.ijscr.2016.01.025

Cited by 5 publications

(7 citation statements)

References 7 publications

(9 reference statements)

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“…Typically, cerebral abscesses from Actinomyces affect adults with predisposing factors including congenital heart defects, chronic otitis media, otologic surgery, chronic sinus infections, dental infections, alcoholism, IV drug use, and infected intrauterine device. [ 5 , 6 , 8 , 10 , 11 , 12 , 13 , 19 ] In the pediatric population, the most common causes include direct extension from chronic otitis media or dental abscess and hematogenous seeding with concomitant congenital heart disease. [ 5 , 6 ] These brain abscesses manifest clinically with symptoms as sequelae of local mass effect by compression of adjacent neural tissue including the venous sinuses, global mass effect by increasing intracranial pressure, or development of hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Giant Actinomyces brain abscess in an immunocompetent child: A management strategy

Chicoine

Griffith-Linsley

Goh

et al. 2021

Surgical Neurology International

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Background: Intraparenchymal brain abscess is a collection of microbes caused by inoculation through direct extension or hematogenous spread. Although rare, intraparenchymal abscesses are potentially fatal and can be detected when patients are symptomatic due to local mass effect on adjacent neural tissue. Brain abscess treatment includes medical management with appropriate antibiotics alone or medical management in combination with surgical debridement. Treatment strategies depend on the size and location of disease, as well as the virulence of the microorganism. Similar to medical management strategies, surgical strategies among providers are not uniform, with variation in approaches from complete extirpation of the abscess, including the abscess wall, to minimally invasive stereotactic needle aspiration. In particular, for children, there are no guidelines for therapy. Case Description: We report a case of giant Actinomycosis right frontal brain abscess in an immunocompetent child without risk factors. A review of the literature for the treatment of brain abscess caused very rarely by Actinomyces in children is performed. Conclusion: Successful treatment of brain access depends on organism and location. The even more uncommon giant intraparenchymal abscesses can be managed with minimal access and prolonged antibiosis, especially when slow-growing organisms are identified. Long-term follow-up should be employed to mitigate missed late failures.

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Section: Discussionmentioning

confidence: 99%

Giant Actinomyces brain abscess in an immunocompetent child: A management strategy

Chicoine

Griffith-Linsley

Goh

et al. 2021

Surgical Neurology International

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“…Pasien dengan penyakit jantung kongenital sianotik, seperti sindrom Eisenmenger, memiliki peningkatan risiko terjadinya abses otak. 5 Usia terjadinya abses otak kardiogenik terbanyak adalah pada dekade pertama kehidupan dengan usia rata-rata 7,19 tahun, tetapi usia yang lebih tua juga dilaporkan. 4 Sindrom Eisenmenger ditandai dengan terjadinya hipertensi pulmonal, pembalikan aliran shunt sentral, dan sianosis, sekunder karena kelainan jantung bawaan yang tidak diperbaiki.…”

Section: Pembahasanunclassified

“…Penyebaran secara hematogen menyebabkan terjadinya beberapa abses (Gambar 6). 1,4,5 Tempat abses otak kardiogenik yang paling umum adalah lobus frontal, temporal, dan parietal diikuti oleh lobus serebelum dan oksipital. 4 Sakit kepala dan muntah adalah gejala yang paling umum sedangkan kejang adalah gejala yang paling jarang.…”

Section: Pembahasanunclassified

“…Secara umum, apabila abses > 2cm maka akan dilakukan intervensi bedah. 5 Pasien dengan defisit neurologis progresif cepat karena efek massa dari abses otak yang dikonfirmasi secara neuroradiologis dipertimbangkan untuk dekompresi mendesak oleh ahli bedah saraf. Jika abses membesar setelah 2 minggu antibiotik atau gagal sembuh setelah 3-4 minggu antibiotik, aspirasi bedah lebih lanjut atau eksisi harus dilakukan.…”

Section: Pembahasanunclassified

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Abses Otak Multipel pada Pasien Dewasa dengan Sindrom Eisenmenger: Laporan Kasus

Surpa

Sugianto

Wahyuninghadi

2022

AKSONA : Aksona: Journal of Neurology and Neuroscience

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Pendahuluan: Abses otak merupakan penyebab morbiditas yang signifikan pada pasien dengan penyakit jantung kongenital sianotik seperti sindrom Eisenmenger. Sindrom Eisenmenger ditandai oleh hipertensi paru ireversibel yang berat dan shunting darah dari kanan ke kiri yang merupakan predisposisi terjadinya abses otak. Tulisan ini melaporkan kasus sindrom Eisenmenger dengan komplikasi abses otak. Kasus: Seorang laki-laki 29 tahun datang dengan keluhan kelemahan pada setengah tubuh bagian kanan yang progresif dan pelo yang dirasakan sejak 8 minggu sebelum masuk rumah sakit. Tidak didapatkan keluhan demam, nyeri kepala, muntah, riwayat cedera kepala dan kejang sebelumnya. Pasien ini baru mengetahui memiliki penyakit jantung bawaan sejak usia 16 tahun dan tidak pernah mendapatkan pengobatan. Tanda vital berada dalam batas normal. Saturasi oksigen pada pasien ini antara 88-92%. Pemeriksaan fisik didapatkan hemiparese kanan, kelumpuhan saraf fasial kanan tipe sentral, disartria, murmur sistolik derajat III/VI di intercostal IV parasternal kiri dan didapatkan jari tabuh. Pemeriksaan laboratorium didapatkan peningkatan hemoglobin (Hb 17,2 g/ dL) namun tidak ada peningkatan jumlah darah putih (WBC). Kultur darah dan sensitivitas bakteri negatif. Foto thorax didapatkan gambaran dextrocardia. Echocardiografi menunjukkan gambaran defek septum ventrikel dengan hipertensi paru aliran bidirectional dominan kanan ke kiri. CT scan kepala didapatkan lesi dengan cincin yang menyerap kontras di daerah parietal kiri dengan perivokal edema. MRI kepala didapatkan lesi multipel berkapsul, bentuk oval dengan batas tegas, tepi ireguler, disertai vasogenik edema disekitarnya, tampak cincin menyerap kontras di regio parietal kiri. Pasien ini membaik signifikan secara neurologis setelah pemberian antibiotik Ceftriaxon dan Metronidazol intravena selama 8 minggu. Kesimpulan: Abses otak multipel dapat merupakan penyulit dari sindrom Eisenmenger pada pasien dewasa dengan penyakit jantung bawaan yang tidak dikoreksi.

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“…Patients with cyanotic CHD often to be at increased risk for cerebral abscess due to polycythemia-induced cerebral infarction, impaired immune function, and bypass of pulmonary phagocytosis (Hall et al, 2016). Cyanotic CHD accounts for nearly 13-70% of all cases of brain abscess and usually, SOL with dimension >2 cm is indicated for surgical intervention (Hall et al, 2016;Raha et al, 2012). Patients with signs and symptomps of increased ICP should receive therapy to reduce ICP, and receive specific consideration when undergoing the surgery (Ozawa et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Management in Patient with Suspected Brain Abscess, Atrium Septal Defect, and Eisenmenger Syndrome

Azhari¹,

Rismawan²

2021

jhms

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Introduction: Patients with congenital heart disease especially with systemic shunting between systemic and pulmonary circulation often develop pulmonary hypertension and left-to-right shunt (Eisenmenger syndrome) if left untreated. These patients are at risk of developing spontaneous brain abscess due to brain infarction caused by polycythemia, impaired immune function, and loss of lung phagocytosis. Such patients were often admitted to the emergency room with signs of increased intracranial pressure (ICP), and needed specific consideration during surgery. Case: a 31-year old female diagnosed with intracranial space occupying lesion (SOL) due to suspected brain abscess with concurrent heart defects (atrial septal defect / ASD and Eisenmenger syndrome) was consulted to the operating theatre for emergency burrhole aspiration. The surgery was performed for an hour and the postoperatively the patient was admitted to the intensive care unit (ICU). Conclusion: perioperative management of patients with brain abscess and concurrent ASD and Eisenmenger syndrome consists of preoperative management, methods of anesthesia, monitoring, and interventions to prevent the worsening of left-to-right shunt and increasing intracranial pressure. These managements consist of optimal pain management, perioperative oxygen therapy, and prevention of precipitating factor that increases left-to-right shunting.

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An intra-cerebral abscess in a patient with Eisenmenger syndrome: An unusual case

Cited by 5 publications

References 7 publications

Giant Actinomyces brain abscess in an immunocompetent child: A management strategy

Giant Actinomyces brain abscess in an immunocompetent child: A management strategy

Abses Otak Multipel pada Pasien Dewasa dengan Sindrom Eisenmenger: Laporan Kasus

Anesthetic Management in Patient with Suspected Brain Abscess, Atrium Septal Defect, and Eisenmenger Syndrome

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