Brain abscess in pediatric age: a review

Mameli, Chiara; Genoni, Teresa; Madia, Cristina; Doneda, Chiara; Penagini, Francesca; Zuccotti, Gianvincenzo

doi:10.1007/s00381-019-04182-4

Cited by 59 publications

(65 citation statements)

References 67 publications

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“…In the pediatric population, factors predisposing to brain abscess development were found in 56-86% of patients. Amidst underlying infectious risk factors are sinusitis, periorbital and orbital cellulitis, otitis media, meningitis, and mastoiditis [4,27,32,33]. No studies considering pediatric brainstem abscesses risk factors were conducted due to low incidence accounting for less than 1% of cerebral abscesses [5].…”

Section: Historical Backgroundmentioning

confidence: 99%

“…It can be easily explained since most of the sinusitis-related abscesses localize in the frontal lobes, which is also the most commonly affected cerebral location for abscesses [27]. Brainstem abscesses tend to spread through a hematogenous route from distant locations such as the lungs or heart, alternatively from primary otogenic infection [32]. Among underlying non-infectious primary predisposing conditions are congenital heart disease, immunodeficiency, and neurosurgical intervention [33].…”

Section: Historical Backgroundmentioning

confidence: 99%

“…Computed tomography allows localizing and identifying a number of abscesses, assessing cerebritis area, and mass effect; however, we cannot discriminate between abscess and tumor. In contrast, MRI allows making a differential diagnosis with different lesions and is associated with less toxicity and better resolution [32,38]. MRI supplied by diffusion-weighted imaging (DWI) allows differentiating abscess from cystic or necrotic lesions.…”

Section: Diagnosis Neuroimagingmentioning

confidence: 99%

“…Sensitivity and specificity for DWI in differentiating brain abscess from other cystic lesions are estimated at 96% [39]. Therefore, many authors state that in the case of brain abscess suspicion, the MRI scan should be the imaging of choice [32,33,38]. CT or MRI abscess features depend on the infection phase and etiology of infection [40].…”

Section: Diagnosis Neuroimagingmentioning

confidence: 99%

“…Blood cultures are positive in 2.8-28.6%; however, studies regarding this issue are inconsistent. CSF utility is also very limited, ranging from 2.8 to 44% of positive cultures [32].…”

Section: Laboratory Findings and Microbiologymentioning

confidence: 99%

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Clinical features, microbiology, and management of pediatric brainstem abscess

2020

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Purpose Brainstem abscess is a rare condition accounting for merely 1% of brain abscesses incidence in the pediatric population. This study aimed to present a single patient with a pontine abscess and review the literature to highlight clinical features, diagnosis, and management of brainstem abscess. Methods The PubMed database was screened for English-language articles concerning pediatric brainstem abscess. We, therefore, identified 22 publications, which concisely depict 23 cases. Our study reports on the 24th pediatric patient diagnosed with that entity. All included reports were analyzed in terms of clinical presentation, diagnosis, management, and outcomes of described patients. Results There was slight women predominance (15:9), with a mean age of occurrence 6.4 years, ranging from 7 months to 16 years. Pons was the most common location of brainstem abscess, occurring in 75% of patients. Clinically, they mostly presented with cranial nerves palsy (79.2%), hemiparesis (66.7%), and pyramidal signs (45.8%). The classic triad of symptoms, including fever, headache, and the focal neurologic deficit was present in 20.8% of patients. Positive pus cultures were obtained in 61.1%. Streptococci and Staphylococci were the most frequently identified pus microorganisms. Outcomes were satisfactory, with a 79.2% rate of general improvement. Conclusions Neurosurgical aspiration is a safe and beneficial therapeutic method. It should always be considered and should promptly be performed when the conservative treatment is not successful and clinical deterioration occurs. Prognosis in pediatric brainstem abscess is generally favorable. Most patients recover with minor neurologic deficits or improve completely.

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Section: Historical Backgroundmentioning

confidence: 99%

Section: Historical Backgroundmentioning

confidence: 99%

Section: Diagnosis Neuroimagingmentioning

confidence: 99%

Section: Diagnosis Neuroimagingmentioning

confidence: 99%

“…Blood cultures are positive in 2.8-28.6%; however, studies regarding this issue are inconsistent. CSF utility is also very limited, ranging from 2.8 to 44% of positive cultures [32].…”

Section: Laboratory Findings and Microbiologymentioning

confidence: 99%

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