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An analysis of 23 consecutive cases of brain abscess is reported. The most frequent early symptoms and signs were headache, vomiting, papiledema, focal neurological abnormalities and pyrexia. Roentgenogram of skull, electroencephahologram and ecoencephalogram were abnormal in all cases in which they were obtained. Therapy was based on early diagnosis with accurate location, aspiration or excision of the abscess. Lumbar puncture is hazardous and yields only suggestive information.
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PMID:[Intracranial abscesses in children]. 30 50

Three cases of brain abscess following an occlusion of the internal carotid artery were reported. Case 1: A 6-year-old girl with congenital heart disease was admitted with headache, disturbance of consciousness and left hemiparesis. Right carotid angiography revealed an occlusion of the right internal carotid artery. After 6 months, she was readmitted with high fever. CT scan revealed a low density area and a ring-like shadow at the same site of cerebral infarction. Case 2: A 69-year-old man was admitted in semicoma and with right hemiplegia. Left angiography revealed an occlusion of the left internal carotid artery. After 2 months, a brain abscess was noted in the infarcted area. Case 3: A 20-year-old man with congenital heart disease, was admitted due to headache, vomiting and high fever. CT scan revealed a brain abscess in the right frontal lobe. Carotid angiography showed bilateral internal carotid artery occlusion. We concluded that diminution of cerebral oxygen and encephalomalacia are predisposing factors to the evolution of brain abscess.
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PMID:[Brain abscess (Part 5)--Brain abscess following internal carotid occlusion (author's transl)]. 49 56

Brain abscess can develop at the site of retained intracranial foreign bodies many years after the injury. This report describes a 6 1/2-year-old child who presented with recurrent severe headaches and a focal seizure of the right upper extremity. Skull X-ray was normal. Computed tomography of the head showed a mass in the left temporoparietal region with a central area of high density and contrast enhancement, thought to be a neoplasm. The mass was seen on the radionuclide brain scan and was avascular on angiography. Craniotomy revealed a foreign body granuloma with a small abscess cavity and a retained piece of pencil graphite. No one in the family could recall if the child had had such an injury.
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PMID:Case report: chronic graphite granulomatous abscess simulating a brain tumor. 61 34

We report a 4 1/2-year-old boy who presented with a 4-week history of frontal headaches and fever, and generalized convulsion 5 months previously. Papilledema, an abnormal EEG and a brain scan with a frontal mass and 'doughnut' sign were found. The association of the clinical history with brain scan findings strongly suggested a brain abscess. At surgery the lesion proved to be an encapsulated hematoma; Histological findings suggest underlying microangiomata.
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PMID:Organizing hematoma in a child presenting as a 'doughnut lesion' on nuclear scan. Case report. 89 2

A case of brain abscess in the right parietal lobe secondary to pulmonary arteriovenous malformation of the right lung is presented. A 27-year-old man was admitted for headache and left homonymous hemianopsia. CAG, VAG and brain scan detected brain abscess of the right parietal lobe which was successfully removed surgically. He had been noted to have generalized cyanosis and club finger which corresponded to polycytemia and hypercapnia on examination. Subsequently pulmonary arteriovenous malformation was found in the right lower lobe of the lung which was also successfully excised by thoracic surgeons. Brain abscess was caused by peptostreptococcus anaerobius.
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PMID:[Brain abscess secondary to pulmonary arteriovenous malformation, case report (author's transl)]. 98 96

Two cases of cerebral abscesses caused by Pseudomonas pseudomallei are reported. The first case, a 51-year-old women had a sudden onset of progressive right hemiparesis and right facial palsy and died within 7 days. Postmortem examination disclosed brain abscess in association with disseminated infection outside the central nervous system. The second case, a 9-year-old boy displayed cerebral abscesses as an isolated manifestation. Recovery occurred after treatment with ceftazidime. Review of the ten case reports of cerebral melioidosis revealed that the lesion occurred in patients of all ages and was more common in men than in women. The frontoparietal lobe was the most common location. Fever, headache, and hemiparesis were frequent clinical manifestations while seizures, ataxia were uncommon. CT scanning, serum antibody titer along with hemoculture were useful investigate tools. The importance of early diagnosis and prompt treatment is emphasized for this fatal but treatable disease.
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PMID:Cerebral abscesses due to Pseudomonas pseudomallei. 128 75

Intracranial complications from otitis media can be quite devastating to the patient if an early diagnosis is not made. Patients may develop meningitis, venous sinus thrombosis or cranial nerve palsies, as well as intracranial abscess. The presenting features in such cases may be subtle and include headache, nausea, vomiting, personality changes and signs of increased intracranial pressure as well as focal neurological deficits. A case of intracranial brain abscess is presented in a patient with a history of chronic otitis media with cholesteatoma. Delay in the diagnosis of intracranial complications of otitis media can lead to improper treatment with increased morbidity and mortality. The etiology and treatment of complications affecting the CNS is discussed.
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PMID:Otitis media and CNS complications. 140 77

The halo traction device for cervical spine immobilization has few complications and is routinely used for spinal cord injured patients. The following case report describes a patient with lower cervical and upper thoracic fractures stabilized with a halo. She completed a two-month rehabilitation program without complications, but developed frontal headaches and vomiting within one or two days of discharge. A head CT revealed a right frontal isodense mass consistent with a brain abscess. The abscess was resected surgically, and she was placed on antibiotics. Mortality rates from brain abscesses are as high as 24%, making a prompt diagnosis critical. This case report describes an unusual etiology for a brain abscess, and it discusses the appropriate work-up in a neurologically impaired patient.
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PMID:Brain abscess: a rare complication of halo usage. 158 Jul 80

Neurologic syndromes often complicate the management of infective endocarditis (IE). We retrospectively reviewed 166 episodes of native valve endocarditis to assess the occurrence and implications of nonfocal encephalopathy, meningitis, salient headache, back pain, and brain abscess. Neurologic complications occurred in 35% (58/166) of patients: 41% (54/133) of mitral or aortic valve IE and 12% (4/33) of tricuspid valve IE. Of 133 cases of mitral or aortic valve IE, encephalopathy occurred in 14%, meningitis in 5%, and salient headache in 3%. All neurologic complications occurred more often with Staphylococcus aureus infection (67%) than with viridans streptococci (22%), including encephalopathy (22% versus 7%), meningitis (17% versus 0%), stroke (39% versus 16%), and death (39% versus 9%). Encephalopathy was associated with virulent organisms, increased patient age, and uncontrolled infection. Clinical, radiologic, and neuropathologic data all suggest that infective microemboli are often etiologic in IE-related encephalopathy. There were no macroscopic brain abscesses clinically identified. Meningitis occurred only with virulent organisms. While many clinical aspects of IE have changed in recent years, the frequency and gravity of neurologic complications have not.
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PMID:Neurologic complications of infective endocarditis. 182 93

Twenty-eight episodes of nocardial central nervous system infection fulfilling criteria for meningitis were reviewed. In 21 cases Nocardia was cultured from cerebrospinal fluid (CSF). Associated predisposing conditions were present in 75% of cases. The typical presentation was subacute to chronic meningitis characterized by fever (68%), stiff neck (64%), and headache (55%). CSF studies revealed neutrophilic pleocytosis (83% of cases, greater than 500 white blood cells/mm3), hypoglycorrhachia (64%, less than 40 mg of glucose/dL), and elevated protein level (61%, greater than 100 mg/dL). In 43% of cases there was an associated brain abscess. Patients with brain abscess had more frequent and severe aberrations in mental status as well as higher initial white blood cell counts in CSF. Mortality was 52% for the 23 cases diagnosed antemortem and 57% overall. Compared with patients who died, survivors were younger, had lower initial CSF glucose levels, and were less likely to have brain abscess. Diagnosis was often delayed, and nocardial infection was rarely suspected before positive culture reports or autopsy findings became available.
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PMID:Nocardial meningitis: case reports and review. 201 17


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