Brain abscess developing at the site of preciding intracerebral hemorrhage

Inamasu, Joji; Kono, Hiroshi; Nakamura, Yoshiki; Saito, Ryoichi; Niimi, Maki; Ichikizaki, Kiyoshi

doi:10.1007/pl00007869

Cited by 17 publications

(10 citation statements)

References 6 publications

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“…Almost all these patients had episodes of bacteremia, sepsis, or local infection such as phlebitis or an infected surgical wound. [3][4][5][6][7][8][9] Our patient developed the abscess in a traumatic intracerebral hematoma with no identifiable focus of infection.…”

Section: Introductionmentioning

confidence: 72%

Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

2009

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We report a 57-year-old man who presented one month after sustaining a traumatic right temporal intracerebral hematoma with history of headache, left hemiparesis and altered sensorium of two days duration. A diagnosis of right temporal resolving hematoma was made on computed tomography scan. However, his sensorium progressively deteriorated and he underwent craniotomy and partial excision of an abscess. He was treated with appropriate antibiotics for six weeks despite of which he did not improve and died nine months later. We conclude that there should be a high index of suspicion for brain abscess in patients with traumatic intracerebral hemorrhage if the clinical and radiological picture is different from the expected course of a resolving hematoma.

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Section: Introductionmentioning

confidence: 72%

Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

2009

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“…Only 19 cases of brain abscess at the site of previously untreated ICHs have been reported in literature (Table I) (1)(2)(3)(4)(5)(6)(7)(8)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Spontaneous ICHs are predominant in the basal ganglia and cause damage to the blood-brain barrier.…”

Section: Discussionmentioning

confidence: 99%

Brain abscess developing in a non-operated spontaneous intracerebral haemorrhage: case report and literature review.

Rigante

Tufo²,

Scoppettuolo³

et al. 2012

Turkish Neurosurgery

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Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage. KeywOrds: Brain abscess, Intracerebral haemorrhage, Stroke ÖZBeyin apseleri genellikle immün yetmezlikli hastalarda septik episodlar sonrasında gelişen veya nöroşirürji işlemlerinin komplikasyonları olarak görülen nadir ama ölümcül olabilen nörolojik lezyonlardır. Cerrahi olarak tedavi edilen intraserebral hemorajilerin bilinen komplikasyonları olsalar da tedavi edilmemiş bir intraserebral hemoraji bölgesinde bir beyin apsesi bulunması nadir bir durumdur. Bu tür olgular uzak odaklardan veya komşu bölgelerden hematojen yayılmanın sonucu olabilir ve sıklıkla öncelerinde sepsis ve yerel enfeksiyon episodları görülür. İmmünyetmezlik, AIDS, yaş, diabetes mellitus ve K vitamini eksikliği predispozan faktörlerdir. Apse oluşumu febril episodlardan sonra herhangi bir nörolojik defisit, başağrısı ve klinik durumda bozulma durumunda dikkate alınmalıdır. Nöroradyolojik testler, enfeksiyon kan işaretleri ve neden olan patojenin mikrobiyolojik olarak tanımlanması uzun dönemli iyi prognoz ve uzun dönemli sağkalımı garanti edecek şekilde cerrahi drenaj veya eksizyon ve spesifik antibiyotik tedavisiyle tedavi amacıyla erken tanı için şarttır. Hatta erken tanı ve tedavi iyi prognoz ve uzun dönemli sağkalımı garanti ederken yanlış tanı durumunda morbidite ve mortalite çok yüksektir. Daha önce sepsis episodu olmadan, spontan intraserebral kanamadan 13 hafta sonra beyin apsesiyle gelen ve apse drenajından 2 hafta sonra septik artrit durumundan şüphelenilen 49 yaşında bir erkek hastayı sunuyoruz.

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“…In this report, patient had a respiratory tract infection caused by Pseudomonas aeruginosa and Staphylococcus aureus, blood culture positive for anaerobic gram-positive cocci in chains, and Streptococcus sp isolated in the abscess secretion. Brain abscess developed five weeks after the stroke, although it took longer to be diagnosed in more than 70% of the cases reported in the literature [9][10][11][12][13][14][15] . The reduced delivery of antibiotics to ischemic areas decreases the effectiveness of treatment and prolongs its course 16,17 .…”

Section: Discussionmentioning

confidence: 99%

Brain abscess following ischemic stroke with secondary hemorrhage

Kraemer¹,

Worm²,

Faria³

et al. 2008

Arq. Neuro-Psiquiatr.

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Cerebral vascular events constitute the most common group of neurological diseases, and are usually followed by systemic infections, being pneumonia, urinary tract infection and sepsis the most frequent 1 . Brain abscess compromising the infarcted cerebral tissue is a rare condition 2,3 . It most frequently happens a few weeks after an infectious systemic insult, which had usually followed the ischemic stroke. There are only a few case reports on this subject in the literature. In spite of that, those patients with ischemic stroke should be considered at high risk of developing brain abscess, and should have this condition included in their differential diagnosis once neurologic or even systemic deterioration takes place following previous recovery. Cerebral ischemia is considered to be a predisposing factor for the genesis of brain abscess after stroke 4 . Due to impaired cerebral oxigenation and blood brain barrier disruption in the infarcted area, the formation of an abscess becomes feasible following bacteremia, a fact that has recently caught the attention of neurologists and neurosurgeons 2,3,5 . CASEA previously healthy 33-year-old white woman is admited to the emergency room complaining of severe right hemiparesis of acute onset and motor disphasia, which progressed to complete aphasia in a few minutes. Brain computed tomography (CT) revealed no abnormalities. Due to the hypothesis of acute obstruction of the left middle cerebral artery (MCA), a cerebral angiography was performed five hours after the onset of the symptoms, indicating oclusion of the distal portion of the left intracranial carotid artery, compromising both anterior and middle cerebral arteries. Intra-arterial thrombolytics were administered, with total reperfusion of the anterior cerebral artery territory. A MCA suboclusion (M2 segment) remained, despite multiple attempts to perform angioplasty with stent deployment. Patient was transferred to the intensive care unit (ICU) and was started on intravenous anticoagulants. About 24 hours after the procedure, patient developed anisocoria with left mydriasis, and tomographic evidence of hemispheric edema compromising the left MCA distribution with intracerebral hemorrhage and significant mass effect. A decompressive craniotomy was performed, and a ventricular catheter for intracranial pressure (ICP) measurement was placed (Fig 1).Elevated ICP was managed with mannitol and hypertonic saline. Four days after the ictus, patient developed fever (38 o C)with negative blood cultures. Pseudomonas aeruginosa and Staphylococcus aureus were then isolated in the tracheal aspirate, being both ciprofloxacin sensitive. Patient persisted febrile after seven days of antimicrobial therapy, and the previous germs were both once again isolated in the tracheal aspirate. Anaerobic gram positive cocci disposed in chains were identified in the blood culture; piperacilin and tazobactan for ciprofloxacin resistant pseudomonas were introduced, with favorable outcome. Seven weeks after the stroke, patient started with lo...

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Brain abscess developing at the site of preciding intracerebral hemorrhage

Cited by 17 publications

References 6 publications

Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

Brain abscess in a non-penetrating traumatic intracerebral hematoma: Case report and review of literature

Brain abscess developing in a non-operated spontaneous intracerebral haemorrhage: case report and literature review.

Brain abscess following ischemic stroke with secondary hemorrhage

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