Management of brain abscess: an overview

Moorthy, Ranjith K; Rajshekhar, Vedantam

doi:10.3171/foc/2008/24/6/e3

Cited by 119 publications

(145 citation statements)

References 51 publications

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“…Therefore surgical intervention is essential once the capsule is formed. [17][18][19][20] Hence brain abscess following CSOM can be effectively managed if evolution pattern is known, as the treatment is mainly based on the stage of abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Otogenic brain abscess and its management with review of literature

Melkundi¹,

Melkundi

2017

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONOtogenic brain abscess is a relatively common problem in developing countries, where the prevalence of chronic suppurative otitis media (CSOM) is reported to be in the range of 30-40% and 0.5%-1% of developing brain abscess. The most commonly encountered intracranial complication is meningitis followed by brain abscess. The mortality of the brain abscess is in the range of 30-40%. 1 The eradication of infection in the brain and the ear is a major challenge which was realized as early as 1893 by Sir Williams Macewan, who described mastoid approach to both the abscesses. However with the development of otology and neurosurgery as separate entities, otologists started relying on neurosurgeons for the intracranial abscess removal followed by mastoidectomy. 2Hence the standard treatment for otogenic brain abscess evolved in two separate procedures addressing primary focus in mastoid its secondary complications in the brain, each with its own surgical mortality and morbidity. 3,4 Chronic otitis media with cholesteatoma and/or granulation tissue are usually the cause. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. The first line of treatment is antibiotic, followed immediately by surgical evacuation of the abscess and cleansing the sources of infection.6 CT-scanning is the best available diagnostic tool. 1Due to improvement in the surgical and anesthesia techniques, recently the advantages of eradicating the ABSTRACT Background: Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The objective of this study is to present our experience in the management of otogenic brain abscess by neurosurgical and otolaryngological surgery simultaneously. Methods: It is a retrospective study conducted between 2006-2015. 20 patients with otogenic brain abscess were admitted to neurosurgery and ENT wards for management were included in the study. On admissions patients had ENT, neurosurgery and neurological examinations. All the patients underwent neurosurgery followed by mastoidectomy. Repeat CT scanning/ MRI scanning done after 1 week to check for the success of the surgery and discharged on the 10th day after suture removal. Patients were followed up for 1-2 years. Results: The study included sixteen males and four females. Their age ranged between 4-32 years with mean of 18 years. Their chief complaints were severe headache, vomiting and fever with unilateral and or bilateral foul smelling discharge. Brain and HRCT temporal bone CT scanning showed equal incidence of abscess on the sides with 8 cerebellar, 6 temporal, 5 tempero parietal and 1 fronto parietal abscess. After completion of surgery, eighteen patients improved and two patents expired due to septic shock. Conclusions: This is technically more feasible technique with an added advantage of single anaesthesia, short stay of patient in the hospital and early disease clearance in the same procedure.

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Section: Discussionmentioning

confidence: 99%

Otogenic brain abscess and its management with review of literature

Melkundi¹,

Melkundi

2017

Int J Otorhinolaryngol Head Neck Surg

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“…In contrast, Benedetti et al and Murray et al reported gemella brain abscess after 3 weeks of antibiotic therapy for gemella meningitis. In anticipation of complete eradication of the gemella, it is needs to be emphasized that whatever regimen is used, it should be continued for a period not less than 6 weeks, (12) or continued till the C reactive protein falls to normal levels (6).…”

Section: Discussionmentioning

confidence: 99%

“…As well comprehended, CT guided stereotactic aspiration is the modality of choice with deep seated and multiple abscesses (9,(11)(12). Messori et al (11) reports the use of stereotactic aspiration in a patient with a fronto parietal abscess, who then developed a cortical lesion at the site of the needle procedure.…”

Section: Discussionmentioning

confidence: 99%

Brain abscess caused by gemella morbillorum: a case report and review of literature

Chotai

Hj²,

Kim³

et al. 2010

Turkish Neurosurgery

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We describe a rare case of cerebral abscess in an immunocompetent 67-year-old male with Gemella morbillorum as the causative agent. Gemella morbillorum is an aerobic gram positive coccus and is deemed to be a normal inhabitant of the oral cavity. The aim of this report is to introduce Gemella morbillorum as the emerging pathogen involved in brain abscesses. To the best of our knowledge only eight cases of Gemella morbillorum brain abscess have been reported in the literature. An exhaustive review of the literature is included with emphasis on the primary source of infection, clinical presentation, radiological diagnosis, and treatment modalities. KeywoRds: Brain abscess, Gemella morbillorum, Odontogenic infections, Immunocompetent, Latency ÖZİmmünokompetan 67 yaşında bir erkek hastada etkenin Gemella morbillorum olduğu nadir bir serebral apse vakası sunuyoruz. Gemella morbillorum aerobik gram pozitif koktur ve normalde oral kavitede bulunur. Bu raporun amacı, Gemella morbillorum'un beyin apselerinde giderek saptanmakta olan bir patojen olarak belirlenmesidir. Bildiğimiz kadarıyla literatürde sadece sekiz Gemella morbillorum beyin apsesi olgusu mevcuttur. Primer enfeksiyon kaynağı, klinik sunum, radyolojik tanı ve tedavi modaliteleri vurgulanarak literatür kapsamlı bir şekilde gözden geçirilmiştir.

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“…Management of a usual brain abscess includes either aspiration by various techniques and 6-8 weeks of antibiotics. In patients unresponsive to antibiotics, large abscesses causing significant mass effect and neurological deficits, and in multi-loculated abscesses craniotomy and excision of abscesses is indicated 3 . A deficiency of vitamin K-dependent clotting factors, decreased and defective platelets, and accelerated fibrinolysis results in abnormal hemostasis with frequent and increased bleeding.…”

Section: Discussionmentioning

confidence: 99%