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Childhood brain abscess: a single center experience

Year 2017, Volume: 42 Issue: 3, 427 - 435, 30.09.2017
https://doi.org/10.17826/cutf.296415

Abstract

Purpose: Childhood brain abscesses are rare but potentially life-threatening, is a condition that requires immediate diagnosis and treatment. In this study, 10 pediatric brain abscess in the clinical manifestations, predisposing factors, distribution, localization, radiological features, and is intended to offer the choice of treatment in our clinic observation about the prognosis.
Material and Methods: Demographic data, complaints, signs and symptoms, predisposing factors, abscess localization, radiological findings, isolation of micro-organisms and treatment options have been examined retrospectively from the register prognosis and outcome. 
Results: 60% of patients complaining of fever and neurological examination, 60% varying degrees of changes in consciousness, nausea and vomiting 50%, 40% seizures have been identified. As predisposing factors otitis media-mastoiditis 3 cases, secondary to trauma abscess in 2 cases, the ventriculo-peritoneal shunt after meningitis 2 cases, pulmonary infection in 1 case, subacute bacterial endocarditis was found in 1 case was detected etiology in 1 patient. Only 1 patient medical therapy as a treatment method, 9 patients underwent surgical treatment (5 patients with excision of the capsule, 4 cases of burr hole aspiration) were applied. The mortality rate was found to be 10%.
Conclusion: Despite the increased use of antibiotics, otitis media and mastoiditis, meningitis due to trauma and ventriculo-peritoneal shunt is an important predisposing factor for brain abscess. 

References

  • 1. Frazier JL, Ahn ES, Jallo GI. Management of brain abscesses in children. Neurosurg Focus. 2008;24:E8.
  • 2. Ozsürekci Y, Kara A, Cengiz AB, Celik M, Ozkaya-Parlakay A, Karadağ-Oncel E et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr. 2012;54:144-9.
  • 3. Yogev R, Bar-Meir M. Management of brain abscesses in children. Pediatr Infect Dis J. 2004;23:157-9.
  • 4. Demirören K, Gülşen İ, Ece İ, Garipardıç M, Sevgin B, Bulut MD et al. Çocuklarda intrakraniyal apse. Van Tıp Dergisi: 2015:22:67-72.
  • 5. Canpolat M, Ceylan O, Per H, Koc G, Tumturk A, Kumandas S et al. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. J Child Neurol. 2015;30:458-67.
  • 6. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. 2010;99:1163-7.
  • 7. Auvichayapat N, Auvichayapat P, Aungwarawong S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007;90:1601-7.
  • 8. Hakan T, Ceran N, Erdem I, Berkman MZ, Göktaş P. Bacterial brain abscesses: an evaluation of 96 cases. J Infect. 2006;52:359-66.
  • 9. Tsou TP, Lee PI, Lu CY, Chang LY, Huang LM, Chen JM et al. Microbiology and epidemiology of brain abscess and subdural empyema in a medical center: a 10-year experience. J Microbiol Immunol Infect. 2009;42:405-12.
  • 10. Nathoo N1, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg. 2011;75:716-26.
  • 11. Sarmast AH, Showkat HI, Bhat AR, Kirmani AR, Kachroo MY, Mir SF et al. Analysis and management of brain abscess; a ten year hospital based study. Turk Neurosurg. 2012;22:682-9.
  • 12. Gaskill SJ, Marlin AE: Brain abscesses abd encephalitis. In Principles and Practice of Pediatric Neurosurgery, 2nd Edition (Eds AL Albright, IF Pollack, PD Adelson PD):1162-81. New York, Thieme, 2008.
  • 13. Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus. 2008;24:E6.
  • 14. Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst. 1999;15:309-17.
  • 15. Kao KL, Wu KG, Chen CJ, Wu JJ, Tang RB, Chang KP et al. Brain abscesses in children: analysis of 20 cases presenting at a medical center. J Microbiol Immunol Infect. 2008;41:403-7. 16. Radoi M, Ciubotaru V, Tataranu L. Brain abscesses: clinical experience and outcome of 52 consecutive cases. Chirurgia (Bucur). 2013;108:215-25.
  • 17. Hirsch JF, Roux FX, Sainte-Rose C, Renier D, Pierre-Kahn A. Brain abscess in childhood. a study of 34 cases treated by puncture and antibiotics. Childs Brain. 1983;10:251-65. 18. Tekkök IH, Erbengi A. Management of brainabscess in children: review of 130 cases over a period of 21 years.Childs Nerv Syst. 1992;8:411-6.
  • 19. Wong TT, Lee LS, Wang HS, Shen EY, Jaw WC, Chiang CH et al. Brain abscesses in children--a cooperativestudy of 83 cases Childs Nerv Syst. 1989;5:19-24.
  • 20. De Oliveira RS, Pinho VF, Madureira JF, Machado HR. Brain abscess in a neonate: an unusual presentation.Childs Nerv Syst. 2007;23:139-42.
  • 21. Felsenstein S, Williams B, Shingadia D, Coxon L, Riordan A, Demetriades AK et al. Clinical and emicrobiologic features guiding treatment recommendations for brain abscesses in children. Pediatr Infect Dis J. 2013;32:129-35.
  • 22. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics. 2004;113:1765-70.
  • 23. Landriel F, Ajler P, Hem S, Bendersky D, Goldschmidt E, Garategui L et al. Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes--a 10-year single-center study. Acta Neurochir (Wien). 2012;154:903-11.
  • 24. Mathisen GE, Johnson JP. Brain abscess.Clin Infect Dis. 1997;25:763-79.
  • 25. Etuş V. Çocukluk çağı beyin abseleri. In Pediatrik Nöroşirürji (Eds K Baykaner, Y Erşahin, S Mutluer, M Özek):635-51. Ankara, TND Yayınları, 2014.
  • 26. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC. Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol. 2005;63:442-9.
  • 27. Joshi SM, DevkotaUP. The management of brain abscess in a developing country: are the results any different? Br J Neurosurg. 1998;12:325-8.
  • 28. Erşahin Y, Mutluer S, Güzelbağ E. Brain abscess in infants and children. Childs Nerv Syst. 1994;10:185-9.
  • 29. Ho VH, Wilson MW, Fleming JC, Haik BG. Retained intraorbital metallic foreign bodies. Ophthal Plast Reconstr Surg. 2004;20:232-6.
  • 30. Gower DJ, Horton D, Pollay M. Shunt-related brain abscess and ascending shunt infection. J Child Neurol. 1990;5:318-20.
  • 31. Miller ES, Dias PS, Uttley D. CT scanning in themanagement of intracranialabscess: a review of 100 cases.Br J Neurosurg. 1988;2:439-46.
  • 32. Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci. 2006;13:979-85.
  • 33. Rosenblum ML, Hoff JT, Norman D, Edwards MS, Berg BO. Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg. 1980;52:217-25.
  • 34. Boviatsis EJ, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE. CT-guided stereotactic aspiration of brain abscesses. Neurosurg Rev. 2003;26:206-9.
  • 35. Fritsch M, Manwaring KH. Endoscopic treatment of brain abscess in children. Minim Invasive Neurosurg. 1997;40:103-6. 36. Longatti P, Perin A, Ettorre F, Fiorindi A, Baratto V. Endoscopic treatment of brain abscesses. Childs Nerv Syst. 2006;22:1447-50.
  • 37. Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. 2010;14:79-92.
  • 38. Mampalam TJ, Rosenblum ML. Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery. 1988;23:451-8. 39. Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis. 1992;15:394-401.
  • 40. Takeshita M, Kawamata T, Izawa M, Hori T. Prodromal signs and clinical factors influencing outcome in patients with intra ventricular rupture of purulent brain abscess. Neurosurgery. 2001;48:310-6

Çocukluk çağı beyin abseleri: tek merkez deneyimi

Year 2017, Volume: 42 Issue: 3, 427 - 435, 30.09.2017
https://doi.org/10.17826/cutf.296415

Abstract

Amaç: Çocukluk çağı beyin abseleri nadir görülen ancak potansiyel olarak yaşamı tehdit eden, acil teşhis ve tedavi gerektiren bir durumdur. Bu çalışmada 10 çocukluk çağı beyin absesinde klinik bulgular, predispozan faktörler, yayılma, lokalizasyon, radyolojik özellikler, tedavi seçimi ve prognoz hakkında kliniğimizin gözlemini sunmak amaçlanmıştır.
Gereç ve Yöntem: Hastaların demografik verileri, şikayet, semptom ve bulguları, predispozan faktörler, abse lokalizasyonu, radyolojik bulguları, mikro-organizmaların izolasyonu, tedavi seçenekleri, prognoz ve sonuçları kayıtlardan retrospektif olarak incelenmiştir. 
Bulgular: Hastaların şikayet ve nörolojik muayenelerinde  %60 ateş, %60 değişik derecelerde bilinç değişiklikleri,  %50 bulantı-kusma, %40 epileptik nöbet tespit edilmiştir. Predispozan faktörler olarak otitis media-mastoiditis 3 olgu, travmaya sekonder abse 2 olgu, ventrikülo-peritoneal şant sonrası menenjit 2 olgu, 1 olguda akciğer enfeksiyonu, 1 olguda subakut bakteriyel endokardit saptanmış, 1 olguda etyoloji saptanmamıştır. Tedavi yöntemi olarak 1 hastaya sadece medikal tedavi, 9 hastaya cerrahi tedavi (5 hastaya kapsül eksizyonu, 4 olguya burr hole aspirasyon) uygulanmıştır. Mortalite oranı %10 olarak bulunmuştur. 
Sonuç: Antibiyotik kullanımının artmasına rağmen otitis media ve mastoidit, travma ve ventrikülo-peritoneal şanta bağlı menenjit tabloları beyin abseleri için önemli bir predispozan faktördür. 

References

  • 1. Frazier JL, Ahn ES, Jallo GI. Management of brain abscesses in children. Neurosurg Focus. 2008;24:E8.
  • 2. Ozsürekci Y, Kara A, Cengiz AB, Celik M, Ozkaya-Parlakay A, Karadağ-Oncel E et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr. 2012;54:144-9.
  • 3. Yogev R, Bar-Meir M. Management of brain abscesses in children. Pediatr Infect Dis J. 2004;23:157-9.
  • 4. Demirören K, Gülşen İ, Ece İ, Garipardıç M, Sevgin B, Bulut MD et al. Çocuklarda intrakraniyal apse. Van Tıp Dergisi: 2015:22:67-72.
  • 5. Canpolat M, Ceylan O, Per H, Koc G, Tumturk A, Kumandas S et al. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. J Child Neurol. 2015;30:458-67.
  • 6. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. 2010;99:1163-7.
  • 7. Auvichayapat N, Auvichayapat P, Aungwarawong S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007;90:1601-7.
  • 8. Hakan T, Ceran N, Erdem I, Berkman MZ, Göktaş P. Bacterial brain abscesses: an evaluation of 96 cases. J Infect. 2006;52:359-66.
  • 9. Tsou TP, Lee PI, Lu CY, Chang LY, Huang LM, Chen JM et al. Microbiology and epidemiology of brain abscess and subdural empyema in a medical center: a 10-year experience. J Microbiol Immunol Infect. 2009;42:405-12.
  • 10. Nathoo N1, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg. 2011;75:716-26.
  • 11. Sarmast AH, Showkat HI, Bhat AR, Kirmani AR, Kachroo MY, Mir SF et al. Analysis and management of brain abscess; a ten year hospital based study. Turk Neurosurg. 2012;22:682-9.
  • 12. Gaskill SJ, Marlin AE: Brain abscesses abd encephalitis. In Principles and Practice of Pediatric Neurosurgery, 2nd Edition (Eds AL Albright, IF Pollack, PD Adelson PD):1162-81. New York, Thieme, 2008.
  • 13. Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus. 2008;24:E6.
  • 14. Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst. 1999;15:309-17.
  • 15. Kao KL, Wu KG, Chen CJ, Wu JJ, Tang RB, Chang KP et al. Brain abscesses in children: analysis of 20 cases presenting at a medical center. J Microbiol Immunol Infect. 2008;41:403-7. 16. Radoi M, Ciubotaru V, Tataranu L. Brain abscesses: clinical experience and outcome of 52 consecutive cases. Chirurgia (Bucur). 2013;108:215-25.
  • 17. Hirsch JF, Roux FX, Sainte-Rose C, Renier D, Pierre-Kahn A. Brain abscess in childhood. a study of 34 cases treated by puncture and antibiotics. Childs Brain. 1983;10:251-65. 18. Tekkök IH, Erbengi A. Management of brainabscess in children: review of 130 cases over a period of 21 years.Childs Nerv Syst. 1992;8:411-6.
  • 19. Wong TT, Lee LS, Wang HS, Shen EY, Jaw WC, Chiang CH et al. Brain abscesses in children--a cooperativestudy of 83 cases Childs Nerv Syst. 1989;5:19-24.
  • 20. De Oliveira RS, Pinho VF, Madureira JF, Machado HR. Brain abscess in a neonate: an unusual presentation.Childs Nerv Syst. 2007;23:139-42.
  • 21. Felsenstein S, Williams B, Shingadia D, Coxon L, Riordan A, Demetriades AK et al. Clinical and emicrobiologic features guiding treatment recommendations for brain abscesses in children. Pediatr Infect Dis J. 2013;32:129-35.
  • 22. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics. 2004;113:1765-70.
  • 23. Landriel F, Ajler P, Hem S, Bendersky D, Goldschmidt E, Garategui L et al. Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes--a 10-year single-center study. Acta Neurochir (Wien). 2012;154:903-11.
  • 24. Mathisen GE, Johnson JP. Brain abscess.Clin Infect Dis. 1997;25:763-79.
  • 25. Etuş V. Çocukluk çağı beyin abseleri. In Pediatrik Nöroşirürji (Eds K Baykaner, Y Erşahin, S Mutluer, M Özek):635-51. Ankara, TND Yayınları, 2014.
  • 26. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC. Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol. 2005;63:442-9.
  • 27. Joshi SM, DevkotaUP. The management of brain abscess in a developing country: are the results any different? Br J Neurosurg. 1998;12:325-8.
  • 28. Erşahin Y, Mutluer S, Güzelbağ E. Brain abscess in infants and children. Childs Nerv Syst. 1994;10:185-9.
  • 29. Ho VH, Wilson MW, Fleming JC, Haik BG. Retained intraorbital metallic foreign bodies. Ophthal Plast Reconstr Surg. 2004;20:232-6.
  • 30. Gower DJ, Horton D, Pollay M. Shunt-related brain abscess and ascending shunt infection. J Child Neurol. 1990;5:318-20.
  • 31. Miller ES, Dias PS, Uttley D. CT scanning in themanagement of intracranialabscess: a review of 100 cases.Br J Neurosurg. 1988;2:439-46.
  • 32. Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci. 2006;13:979-85.
  • 33. Rosenblum ML, Hoff JT, Norman D, Edwards MS, Berg BO. Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg. 1980;52:217-25.
  • 34. Boviatsis EJ, Kouyialis AT, Stranjalis G, Korfias S, Sakas DE. CT-guided stereotactic aspiration of brain abscesses. Neurosurg Rev. 2003;26:206-9.
  • 35. Fritsch M, Manwaring KH. Endoscopic treatment of brain abscess in children. Minim Invasive Neurosurg. 1997;40:103-6. 36. Longatti P, Perin A, Ettorre F, Fiorindi A, Baratto V. Endoscopic treatment of brain abscesses. Childs Nerv Syst. 2006;22:1447-50.
  • 37. Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. 2010;14:79-92.
  • 38. Mampalam TJ, Rosenblum ML. Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery. 1988;23:451-8. 39. Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis. 1992;15:394-401.
  • 40. Takeshita M, Kawamata T, Izawa M, Hori T. Prodromal signs and clinical factors influencing outcome in patients with intra ventricular rupture of purulent brain abscess. Neurosurgery. 2001;48:310-6
There are 36 citations in total.

Details

Subjects Health Care Administration
Journal Section Research
Authors

Yurdal Gezercan This is me

Gökhan Çavuş

Ali İhsan Ökten This is me

Gökhan Kuran This is me

Emre Bilgin This is me

Vedat Açık This is me

Burak Olmaz This is me

Publication Date September 30, 2017
Acceptance Date December 14, 2016
Published in Issue Year 2017 Volume: 42 Issue: 3

Cite

MLA Gezercan, Yurdal et al. “Childhood Brain Abscess: A Single Center Experience”. Cukurova Medical Journal, vol. 42, no. 3, 2017, pp. 427-35, doi:10.17826/cutf.296415.