Incidence and Prognosis of Brain Abscess in a Defined Population: Olmsted County, Minnesota, 1935–1981

Nicolosi, Alfredo; Hauser, W. Allen; Musicco, Massimo; Kurland, Leonard T.

doi:10.1159/000110257

Cited by 115 publications

(67 citation statements)

References 25 publications

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“…The epidemiology of BA in our region (incidence, male to female ratio, peak incidence, mortality) was similar to that expected [7,8]. In our survey, at least 2 patients definitely had PAVMs.…”

Section: Discussionsupporting

confidence: 83%

Brain Abscess: A Need to Screen for Pulmonary Arteriovenous Malformations

Gargiulo

Lepore²,

Pasculli³

et al. 2004

Neuroepidemiology

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Background: Pulmonary arteriovenous malformations (PAVMs) are direct connections between an artery and a vein in the pulmonary circulation associated with hereditary hemorrhagic telangiectasia in up to 88% of cases. Patients with PAVMs are at increased risk of brain abscess (BA). This study aimed to provide preliminary data on the prevalence of PAVMs among BA patients. Methods: Administrative hospital discharge forms were used to identify patients with BA; possible PAVM patients were screened. Results: 126 patients with BA were identified. Two patients had undiagnosed PAVMs at the time of admission for BA. The age-adjusted incidence of BA was 6.3 cases/1 million/year, with a male:female ratio of 2.0. Conclusion: Although PAVMs are rare conditions, they play a role in the development of BA. PAVMs are usually not recognized at the time of BA, thus exposing patients to life-threatening risks.

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Section: Discussionsupporting

confidence: 83%

Brain Abscess: A Need to Screen for Pulmonary Arteriovenous Malformations

Gargiulo

Lepore²,

Pasculli³

et al. 2004

Neuroepidemiology

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“…Brain abscesses are rarely encountered in clinical practice and the incidence has been noted to be about 1 case per 100,000 in the general population [10,11]. Several potential mechanisms have been described including expansion from a contiguous focus (e.g., sinusitis or otitis media), hematogenous spread from arterial circulation (e.g., endocarditis or lung abscess) and direct infection from cerebral trauma [12].…”

Section: Discussionmentioning

confidence: 99%

Embolic Brain Abscess in a Patient With Tricuspid Valve Endocarditis and a Patent Foramen Ovale

Suero

2012

J Neurol Res

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Brain abscess results from local or metastatic septic spread to the brain. Approximately, 15-60% of brain abscesses are considered to be cryptogenetic, being the primary infectious site often undetected. Patent foramen ovale (PFO) has been suggested as a potential source of paradoxical embolism; this was suggested after detecting a higher prevalence of PFO in ischemic stroke of unexplained cause. Brain abscess may develop as a consequence of paradoxical infectious emboli from an extracranial infective source. We present the case of a patient with no history of intravenous drug use and no periodontal disease, which was found to have a brain abscess, tricuspid valve endocarditis and the presence of a PFO with right to left shunting with no other source of infection.

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“…For calculations of age dependent incidence rates, the total number of years provided by each patient per decade of life was calculated, and the number of events in that decade expressed as a rate per thousand patient years. For relative risk analyses, age dependent incidence rates were recalculated for age groupings, as presented in general population series from a comparable UK population23 and a general US population 24. A crude estimate of relative risk was obtained by comparison of the PAVM and general population incidence rates for each age group.…”

Section: Methodsmentioning

confidence: 99%

Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia

Shovlin

Jackson

Bamford

et al. 2008

Thorax

306

367

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Background: Brain abscesses and ischaemic strokes complicate pulmonary arteriovenous malformations (PAVMs). At risk individuals are poorly recognised. Stroke/ abscess risk factors have not been defined. Methods: A cohort study of 323 consecutive individuals with PAVMs (n = 219) and/or the commonly associated condition hereditary haemorrhagic telangiectasia (HHT, n = 305) was performed. Most of the 201 individuals with PAVMs and HHT had no respiratory symptoms, and were unaware they had HHT. Anderson-Gill models assessed constant and time dependent potential predictive variables for stroke/abscess, and rate reduction by PAVM embolisation. Results: 57 individuals with PAVMs and HHT experienced brain abscess or ischaemic stroke, usually prior to the diagnosis of underlying PAVMs/HHT. The primary determinants of stroke and abscess risks were unrelated to severity of PAVMs. Males had higher brain abscess rates (hazard ratio 3.61 (95% CI 1.58, 8.25), p = 0.0024); interventional histories and bacteriological isolates suggested dental sources. Once adjusted for gender, there was a marginal association between brain abscess and low oxygen saturation. For ischaemic stroke, there was no association with any marker of PAVM severity, or with conventional neurovascular risk factors. Surprisingly, low mean pulmonary artery pressure was strongly associated with ischaemic stroke (hazard ratio 0.89 (95% CI 0.83, 0.95) per mm Hg increase; p = 6.2610 25 ). PAVM embolisation significantly reduced ischaemic stroke rate (p = 0.028); no strokes/abscesses occurred following obliteration of all angiographically visible PAVMs. The mean PAVM diagnosis-treatment interval was longer, however, when neurological risks were unrecognised. Conclusions: Ischaemic strokes and brain abscesses occur commonly in undiagnosed HHT patients with PAVMs. Risk reduction could be improved.Pulmonary arteriovenous malformations (PAVMs) are abnormal dilated vessels which provide a rightto-left (R-L) shunt between the pulmonary arterial and venous circulations.

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Incidence and Prognosis of Brain Abscess in a Defined Population: Olmsted County, Minnesota, 1935–1981

Cited by 115 publications

References 25 publications

Brain Abscess: A Need to Screen for Pulmonary Arteriovenous Malformations

Brain Abscess: A Need to Screen for Pulmonary Arteriovenous Malformations

Embolic Brain Abscess in a Patient With Tricuspid Valve Endocarditis and a Patent Foramen Ovale

Primary determinants of ischaemic stroke/brain abscess risks are independent of severity of pulmonary arteriovenous malformations in hereditary haemorrhagic telangiectasia

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