Management of brain abscess: Changing trend and experience in Enugu, Nigeria

Ndubuisi, Chika Anele; Ohaegbulam, Samuel C.; Mezue, Wilfred C; Chikani, Mark C; Nkwerem, Sunday; Ozor, Ignatius Ikemefuna

doi:10.4103/njs.njs_46_16

Cited by 15 publications

(12 citation statements)

References 14 publications

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“…17 The reason for the varying incidence between the sexes is unknown but has been noted in both developed and developing countries. 13,14,16,17 We hypothesize that this could be due to hormonal differences.…”

Section: Discussionmentioning

confidence: 99%

“…Septic shock, respiratory failure, seizures, cerebral edema, and cerebral venous thromboses are known complications of intracranial infections. 1,2,4,8,16 Given the complexities in the management of these patients, many children will require critical care services. However, their critical care needs have not been fully investigated.…”

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confidence: 99%

“…However, their critical care needs have not been fully investigated. 2,14,16 This retrospective chart review was performed to evaluate the resources necessary to care for critically ill children with focal intracranial infections at our institution.…”

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confidence: 99%

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Intensive care resources required to care for critically ill children with focal intracranial infections

Lovett

Shah

Moore‐Clingenpeel

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEFocal intracranial infections such as intraparenchymal abscesses or localized infections in the epidural or subdural spaces are relatively rare infections associated with both morbidity and mortality in children. Although children with these infections frequently require surgical intervention, there is a paucity of literature describing the critical care resources required to manage these cases. This retrospective chart review was performed to evaluate the resources necessary to care for critically ill children with focal intracranial infections at the authors’ institution.METHODSThe authors performed a retrospective chart review of cases at their institution by using ICD-9/10 codes to identify children admitted to the pediatric intensive care unit (PICU) for either intracranial abscess or extradural and subdural abscess between 2006 and 2016. All notes, medication administration records, laboratory/imaging results, vital signs, microbiological data, and electroencephalogram results were reviewed. Data were extracted to determine the utilization of the following resources: mechanical ventilation, vasoactive medications, and intracranial pressure (ICP) monitoring. The presence of intracranial hypertension, cerebral edema, seizure, and cerebral venous sinus thrombosis were noted. Pediatric cerebral performance category (PCPC) score was determined based upon the neurological exam at discharge.RESULTSA total of 45 children met the inclusion criteria. Their median age was 9 years (IQR 3–14 years). The incidence of focal intracranial infections in children admitted to the PICU was 0.68/1000 PICU admissions in 2006 and 2.81/1000 admissions in 2016. Thirty-nine children (86.7%) underwent neurosurgical intervention. Twenty patients (44%) required invasive mechanical ventilation, 7 (15.6%) received vasoactive medications, and 11 (24%) had an ICP monitor. Clinical seizures were detected in 12 children, including 2 who had both clinical and subclinical seizures; 1 child had subclinical seizures only. Eight children (17.8%) developed cerebral venous sinus thrombosis. The median PCPC score was 1 (interquartile range [IQR] 1–3). The median PICU length of stay was 6.4 days (IQR 2.2–10.2 days). Children with seizures had a significantly longer hospital LOS than children without seizure.CONCLUSIONSIn this single-center, retrospective study, critical care needs for children with focal intracranial infections varied. Most frequently, patients required close neurological monitoring, and almost half required invasive mechanical ventilation. Future studies should focus on further elucidating the resources required to care for these children as well as detecting factors to identify those children most at risk for complications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Intensive care resources required to care for critically ill children with focal intracranial infections

Lovett

Shah

Moore‐Clingenpeel

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…49 Head trauma has become an important predisposing factor with the increasing incidence of traffic accidents, which requires safety measures. 23 Tooth extraction and treatment for sinusitis may also help to remove the focus of infection and prevent further spread of bacteria. 50 The duration of hospitalization increases the risk of nosocomial infections concomitant with higher mortality.…”

Section: Preventionmentioning

confidence: 99%

“…6 Brain Abscess in India Ravikumar, John Brain Abscess in India Ravikumar, John studies in other countries. 2,5,23 Headache was found to be the most common symptom. Other symptoms include fever, focal neurologic deficit, seizure, nausea, and vomiting.…”

Section: Introductionmentioning

confidence: 99%

Brain Abscess in the Current Decade (2010–2019) in India—A Review

Ravikumar

John

2021

Indian Journal of Neurosurgery

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Brain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.

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