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Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Brain abscess: Typically, ring-enhancing and often multiple.Brain abscess usually shows restricted diffusion on diffusion-weighted MRI images.
Management of phaeohyphomycosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
For a single brain abscess, some form of surgical debridement is probably necessary for consistent cure. In this body site, complete surgical removal of a brain abscess that is ideal may not be possible without serious consequences, but even some careful debulking of the lesion may be helpful in reducing the burden of fungi prior to systemic antifungal therapy. Of course, it is possible that surgery might spread the infection to other tissue planes, but it is likely that debulking the mass of fungi far outweighs any concern about infection spread within the brain. Furthermore, all brain abscesses are accompanied by medical treatment with antifungal agents no matter what the extent of surgery. Although occasionally medical therapy alone for brain abscesses has been successful, there are many failures without a combined surgical/medical approach for brain abscesses; therefore, we encourage the combination approach.
Chronic Otitis Media
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
George G. Browning, Justin Weir, Gerard Kelly, Iain R.C. Swan
In intracranial abscess the presentation is often much more insidious, with low-grade headache, occasionally more severe, mild pyrexia and in the later stages drowsiness, lethargy and weakness. Subdural abscess tends to present more acutely and may be accompanied by fits and focal neurological signs depending upon site, whereas abscess within brain tissue has a notoriously insidious onset with symptoms developing over several days, and neurological signs, dependent upon site, relatively infrequent. Classically, there is an early period of more acute symptoms due to a localized encephalitis with associated brain oedema. The predominant symptoms are headache and vomiting with fever and general malaise. These symptoms then settle as the abscess develops and the more insidious symptoms supervene. The most common sites for otitic intracranial abscess are temporal lobe and cerebellum, as would be expected from their proximity to the temporal bone. The frequency of and mortality from brain abscess have declined markedly in recent years, with mortality of 6–14% quoted in one series.283 The diagnosis is made by CT scanning, which should be undertaken early if any of the above symptoms develop in a patient with COM.
Brain metastasis or nocardiosis? A case report of central nervous system Nocardiosis with a review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Hojin Sun, Mariam Goolam Mahomed, Jaimin Patel
A brain abscess is a collection of pus within the brain parenchyma that can result from surgery, trauma, infection, direct inoculation, hematogenous spread from a different site, or from contiguous spread [6]. The incidence of brain abscesses can be up to 8% of all intracranial masses in developing countries and 1% to 2% in developed countries [7]. CNS nocardiosis often presents as a single abscess or multiple brain abscesses, with locations typically being supratentorial. These abscesses have a higher mortality rate than other etiologies of brain abscesses. Abscesses due to CNS nocardiosis result in mortality rates of 20% in immunocompetent patients and 55% in immunocompromised patients, with mortality rates up to 66% if multiple abscesses are present; mortality rates due to other brain abscesses are as low as 5% to 10% [8].
Anti-infective treatment of brain abscess
Published in Expert Review of Anti-infective Therapy, 2018
Jacob Bodilsen, Matthijs C. Brouwer, Henrik Nielsen, Diederik Van De Beek
Brain abscess is defined as an area of encapsulated pus within the brain parenchyma that can be caused by bacteria, mycobacteria, fungi, and parasites. Although rare, it has a case fatality rate of 10% and approximately 30% of survivors are left with neurological deficits [1]. The first successful treatment by neurosurgery was described by Scottish surgeon William MacEwen in 1893, but major improvement was only reached after the introduction of anti-infective therapy [2,3]. Further advances were also made with the introduction of computed tomography (CT), stereotactic neurosurgery, and magnetic resonance imaging including diffusion weighted imaging [4–6]. Nonetheless, treatment remains challenging involving both neurosurgery and long-term anti-infective therapy and a multidisciplinary approach consisting of neurosurgeons, infectious disease specialists, microbiologists, neurologists and radiologists is essential. The long-term anti-infective treatment may be particularly difficult considering the requirements to antimicrobial spectrum and pharmacokinetic profile, risks of toxicity and side effects, psychological strain on patients associated with long-term treatment and health-care costs. Here, we review the anti-infective treatment of brain abscess.
Hypervirulent Klebsiella Pneumoniae, an Emerging Cause of Endogenous Endophthalmitis in A French Center: A Comparative Cohort Study
Published in Ocular Immunology and Inflammation, 2023
Jean-Philippe Martellosio, Nabil Gastli, Rebecca Farhat, Asmaa Tazi, Pierre Duraffour, Benjamin Rossi, Etienne Canouï, Caroline Morbieu, Annick Billoët, Luc Mouthon, Claire Poyart, Antoine Brézin, Paul Legendre
This study outlines for the first time the high proportion of central nervous system involvement in KP EE patients (four out of eight patients), including three diagnosed with cerebral MRI and one with lumbar puncture. Cerebral MRI showed cerebral abscesses in three out of four patients who underwent this exam, whereas cerebral CT scan did not detect any brain abscess. Only two patients had neurological symptoms, one of whom had a lumbar puncture showing meningitis. Therefore, cerebral MRI should be systematically performed in the case of KP EE, as it may modify treatment, including duration and route of administration of antibiotics. In case of neurological symptoms, a lumbar puncture should also be obtained.