Çocukluk Çağı Beyin Abseleri

Abstract

Amaç: Otitin komplikasyonu olarak beyin absesi sıklığı azalmışıtır. Sinüzitten kaynaklanan beyin absesi ise hem yetişkinlerde hem çocuklarda önemli bir yer teşkil etmektedir. Bu çalışmada otojenik ve sinojenik kaynaklı 6 beyin absesi vakası sunuyoruz.

Gereç ve yöntem: Ocak 2013 ile Mayıs 2017 tarihleri arasında intrakraniyal abse ile yatırılan çocukların verileri geriye dönük olarak değerlendirildi. Önceden belirleyici faktörler, klinik bulgular ve prognoz belirlendi.

Bulgular: İntrakraniyal abse bulunan 8 çocuk arasında 6’sı otogenik ve / veya sinogenik enfeksiyona sahipti. En sık görülen semptom baş ağrısıydı. İntrakraniyal abse 3 olguda epidural, 3 olguda parankimaldi. Etken patojenler olarak  Streptokok intermedius, Streptococcus pyogenes, Provotella ile Propionibacterium acnes tespit edildi. Tüm çocuklara antibiyoterapi ve cerrahi drenaj uygulandı. Nörolojik sekel ve ölüm gerçekleşmedi.

            Sonuç: Sinüzit ve otitis media; antibiyotik kullanımının artmasına rağmen, beyin abseleri  için hala  önemli birer predispozan faktördür.

Keywords

• beyin,abse,çocuk

Brain Abscess In Children

Abstract

Background and aims: Brain abscess as a complication of ear infections has decreased in frequency. By contrast, brain abscess arising from a sinus infection remains an important consideration in both adults and children. Here we present 6 cases with brain abscess due to otogenic or sinogenic complications.

Methods: Data of children hospitalized with intracranial abscess between January 2013 and May 2017 were evaluated retrospectively. Predisposing factors, clinical manifestations, and prognosis were identified

Results: Among 8 children with intracranial abscess 6 had otogenic and/or sinogenic infection. The most frequent symptom was the headache. The intracranial abscess was epidural in 3 cases and parenchymal in 3 cases. Causative pathogens were Streptococcus intermedius, Streptococcus pyogenes, and Propionibacterium acnes with Provotella loescheii.  All children received antibiotics and surgical drainage.  Neurological sequelae and death did not occur

 Conclusion: Despite the increased use of antibiotics, sinüsitis and otitis media is an important predisposing factor for brain abcess.

Keywords

• Brain,Abscess,Children

References

1. 1. 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(8):1163-1167.
2. 2. Ravdin JI. Brain abcesses. In: Mandell GL, Bennet JE, Dolin R, eds. Principles and Practice of Infectious Diseases. New York: Churchill Livigstone, 1995:1016-28.
3. 3. Ersabin Y, Mutluer S, Güzelbağ E. Brain abcess in infants and children. Childs Nerv Syst 1994; 10: 185-9.
4. 4. Weil ML, Tuomanen E, Israele V, Rust R, Menkes JH. Infections of the nervous system. In: Menkes JH, Sarnat HB, eds. Child Neurology. Philadelphia: Lippincott Williams&Wilkins, 2000:500-6.
5. 5. Dubey SP, Larawin V: Complications of chronic suppurative otitis media and their management. Laryngoscope 117:264–267, 2007
6. 6. Joshi SM, Devkota UP: The management of brain abscess in a developing country: are the results any different? Br J Neurosurg 12:325–328, 1998
7. 7. Kurien M, Job A, Mathew J, Chandy M: Otogenic intracranial abscess: concurrent craniotomy and mastoidectomy—changing trends in a developing country. Arch Otolaryngol Head Neck Surg 124:1353–1356, 1998
8. 8. Ciurea AV, Stoica F, Vasilescu G, Nuteanu L: Neurosurgical management of brain abscesses in children. Child’s Nerv Syst 15:309–317, 1999

9. 9. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC: Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol 63:442–450, 2005
10. 10. Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus 2008; 24(6):E6.
11. 11. . Frazier JL, Ahn ES, Jallo GI: Management of brain abscesses in children. Neurosurg Focus 24: E8, 2008
12. 12. . Gaskill SJ, Marlin AE: Brain abscesses and encephalitis, in Albright AL, Pollack IF, Adelson PD (eds): Principles and Practice of Pediatric Neurosurgery, ikinci baskı, New York: Thieme, 2008: 1162-1181
13. 13. Greenberg MS: Cerebral abscess, in Greenberg MS (ed): Handbook of Neurosurgery, yedinci baskı, New York: Thieme, 2010: 350-353
14. 14. Lerner DN1, Choi SS, Zalzal GH, Johnson DL. Intracranial complications of sinusitis in childhood Ann Otol Rhinol Laryngol. 1995 Apr;104(4 Pt 1):288-93.
15. 15. Garin A, Thierry B, Leboulanger N, Blauwblomme T, Grevent D, Blanot S, Garabedian N, Couloigner V. Pediatric sinogenic epidural and subdural empyema: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol. 2015 Oct;79(10):1752-60. doi: 10.1016/j.ijporl.2015.08.007. Epub 2015 Aug 13.
16. 16. 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.
17. 17. 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
18. 18. 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.
19. 19. 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.
20. 20. Yogev R, Bar-Meir M. Management of brain abscesses in children. Pediatr Infect Dis J. 2004;23:157-9
21. 21. Hakan T, Ceran N, Erdem I, Berkman MZ, Göktaş P. Bacterial brain abscesses: an evaluation of 96 cases. J Infect. 2006;52:359-66.
22. 22. 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
23. 23. 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.