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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-three cases of brain abscess were treated at Mackay Memorial Hospital from January 1991 through December 2001. The ages ranged from 2 weeks to 84 years, with a peak at 40 to 50 years (11/53, 21%). The male to female ratio was 1.8:1 (34 males, 19 females). The most common presenting symptoms were fever (30/53, 57%), headache (29/53, 55%), and changed mental status (24/53, 45%). The duration of symptoms before hospitalization ranged from several hours to 2 months. A shorter duration of symptoms was associated with poor outcome. The common predisposing factors were otic infection (10/53, 19%), penetrating head trauma and neurosurgery (10/53, 19%), and bacterial endocarditis (5/53, 9%). The leading underlying diseases were diabetes mellitus (12/53, 23%) and/or liver cirrhosis (6/53, 11%), and both were independently associated with increased risk of mortality. Computed tomographic scanning and magnetic resonance imaging facilitated early diagnosis and proper management. Surgical intervention was used together with antibiotics in 33 (62%) of 53 patients in whom the average abscesses diameter was 3.75 cm (range, 2-6 cm). The remaining 20 (38%) patients whose average abscesses diameter was 2.3 cm (range, 1-3.5 cm) were treated with antibiotics only. Culture of material drained from abscesses isolated 27 microorganisms from 19 (58%) of the 33 patients, 81% (22/27) of which were aerobic and 19% (5/27) anaerobic bacteria. The most common pathogen was alpha-hemolytic Streptococcus spp. (6/27, 22%). Most of the patients with Klebsiella pneumoniae isolated from brain abscess, cerebrospinal fluid, and blood cultures were diabetic. A high mortality rate (9/20, 45%) was found in patients with medical treatment. A high index of suspicion is needed for the early diagnosis of brain abscess, particularly in patients with predisposing factors. In this series, early diagnosis using computed tomography and/or magnetic resonance scanning, optimal timing of surgery, and appropriate use of antibiotics were associated with improved outcome.
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PMID:Brain abscess: clinical analysis of 53 cases. 1288 65

The authors report on 20 immunocompetent patients with brain abscess after 12 cases of middle ear, seven tooth and a single frontal sinus infection. The clinical aspects, hematochemical and microbiological data, the role of imaging diagnostics (CT, MR) and the type of treatment are analysed. Neurosurgery was performed on 17 patients (85%), eight of whom subsequently underwent evacuation of the primary source of infection (four mastoidectomies, two timpanoplasties, two tooth extractions). Mastoidectomy was eventually carried out on one of the three patients who did not undergo neurosurgery. Microbiological diagnosis was possible in nine patients through culture examination: Proteus mirabilis in three cases, Peptostreptococcus sp. in two, Micrococcus varians, Proteus vulgaris, Streptococcus sanguis and Streptococcus viridans not typed in single cases. The pus was sterile in eight patients (47.1% of those operated). An association of two antimicrobial agents was used in 18 patients, while in two cases monotherapy was preferred, based on the isolated bacteria. Treatment lasted on average 38 days. The most frequently used therapy regimen (75%) was the association of a beta-lactam drug with chloramphenicol or metronidazole. Therapy was successful in 19/20 patients; one patient died. There was no significant difference in prognostic terms with regard to sex, age, duration of symptoms prior to diagnosis, clinical picture at onset, number and size of abscesses or type of treatment. Recognising the first clinical signs and symptoms (headache, fever, alterations in consciousness, focal neurological deficit, epileptic seizures) is extremely important for prompt diagnosis of brain abscess.
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PMID:[Brain abscesses after extracranial infections of the head and neck area]. 1452 35

Brain tumors not uncommonly display a chronic course, with symptoms occurring insidiously. This case report describes a meningioma patient who presented sudden onset and rapidly progressing symptoms. She was 49 years old, a referred case from a nearby hospital, with severe headache and fever. This was also accompanied by unconsciousness and left hermiparesis which necessitated emergency brain CT and MRI scanning. A right temporal 5 cm ring enhancing lesion with massive surrounding edema was revealed. Despite osmotic diuretics to relieve brain edema, symptoms worsened, so decompressive right temporal craniotomy and total excision of the tumor was performed. This mass lesion was found to be extra axial, with histology revealing on atypical meningioma with massive necrosis. This rare case which is thought to be due to massive peritumoral edema, possibly from an ischemic occluded major feeder, conforms to glioma radiologically; while the clinical picture has a similarity to brain abscess. This case is presented as a reminder to neurosurgery practice that meningioma can also be a possibility when a ring enhancing cerebral mass in encountered and is accompanied by such a bizarre sudden and rapidly progressing neurologic condition.
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PMID:[A case of atypical meningioma associated with acute deterioration and cerebral herniation]. 1471 45

Brain abscess is a potentially life-threatening complication that is only rarely associated with pregnancy. Although predispositions such as a preexisting infection, foreign body, or immunosuppression are often present, up to 30% of individuals could have no risk factors. Presenting symptoms are often nonspecific but suggestive of a central nervous system process and include headache, seizures, mental status changes, and focal neurologic deficits. Cranial imaging by computed tomography (CT) or magnetic resonance imaging (MRI) can suggest the diagnosis of abscess. Diagnosis is confirmed by aspiration of purulent material. Treatment involves antibiotics, often with surgical drainage. Vaginal delivery at term appears to be safe. Care of the affected gravida, including time and route of delivery, should be approached by a team representing perinatology, neurosurgery, infectious disease, and anesthesiology.
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PMID:Brain abscess complicating pregnancy. 1510 10

A 13-year-old female is presented. When she was six years old, she had fallen, holding wooden chopsticks and got stuck with a chopstick in the right upper eyelid. She was brought to a physician immediately, but a residual foreign body was missed and no particular symptom had developed during 7 years. She visited our department with fever and headache, and a brain abscess and an intracranial foreign body were found on computed tomography (CT) and magnetic resonance image (MRI) 7 years after the penetrating injury. She underwent removal of the object and abscess by craniotomy and recovered without neurological abnormalities. Since intracranial retained wooden foreign bodies frequently cause delayed complications of severe central nervous system infection, surgical removal is necessary even in the absence of symptoms.
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PMID:A case of delayed brain abscess due to a retained intracranial wooden foreign body: a case report and review of the last 20 years. 1525 7

Brain abscess is a life-threatening infection caused by spread from infected parameningeal or remote foci. Historically, streptococci have been the predominant organisms reported while brain abscess metastatic from liver abscess caused by Klebsiella pneumoniae has been a more recent emerging problem. This study retrospectively analyzed the characteristics of community-acquired brain abscess admitted during an 11-year period. There were 17 men and 7 women with age from 20 to 82 years (median, 41 years). The most common source of infection was liver abscess, followed by otitic infection and sinusitis. The classic triad of fever, headache and focal neurologic deficit was noted in only 25% of cases. Spread of the abscess to multiple lobes was common (n = 6). The most commonly identified organisms were Streptococcus spp. (n = 7) and K. pneumoniae (n = 5). All 5 cases of K. pneumoniae brain abscess also had concomitant pyogenic liver abscess and 4 of them had diabetes mellitus. In this study, brain abscess was common in young patients and in patients with diabetes mellitus. In Taiwan, Streptococcus spp. and K. pneumoniae are leading etiologies for community-acquired brain abscess. Liver abscess is the most likely source of K. pneumoniae brain abscess.
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PMID:Community-acquired brain abscess in Taiwan: etiology and probable source of infection. 1534 Jun 51

Advances in the diagnosis and treatment of brain abscess and subdural empyema with neuroimaging techniques such as computerized tomography, magnetic resonance imaging, magnetic resonance spectroscopy, the availability of new antimicrobials, and the development of novel surgical techniques have significantly contributed to the decreased morbidity and mortality associated these infections. Determination of point of entry and source of infection is paramount to adequate treatment. A high index of suspicion along with typical clinical presentation of headache, seizures, or focal neurologic signs can lead to early diagnosis so that effective therapy can be instituted as soon as possible. This review discusses etiology and pathology of brain abscess and subdural empyema, neuroimaging techniques useful in the diagnosis, and optimal treatment, including use of antimicrobials and surgical procedures.
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PMID:Diagnosis and management of brain abscess and subdural empyema. 1550 45

We experienced two cases of brain abscess secondary to middle ear cholesteatoma. One, a 61-year-old woman, presented with left otalgia, appetite loss and nausea. The computed tomography obtained on admission revealed a middle ear cholesteatoma. The magnetic resonance image showed the presence of a brain abscess in the cerebellum. The brain abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. Part of the cholesteatoma invaded the posterior cranial fossa was could not be removed from the otological surgical field. The patient has been under observation as an outpatient for 6 months already and no abnormal signs have been detected. The other patient, a 55-year-old man, was admitted to our hospital for a detailed examination because he had right otalgia and progressive headache. The examination of spinal fluid obtained by lumbar puncture showed marked elevation of the white blood cells count. Computed tomography revealed a middle ear cholesteatoma. The magnetic resonance image obtained on admission showed an area of low-intensity encapsulated by an area of high-intensity in the right temporal lobe. The abscess was drained and the cholesteatoma was removed using the canal down procedure under general anesthesia. The patient has been under observation for 1 year already and has presented no signs of recurrence.
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PMID:Brain abscess secondary to the middle ear cholesteatoma: a report of two cases. 1654 8

Status migrainosus and brain abscess are uncommon complications of migraine and infectious diseases, respectively. We describe a woman with a history of migraine with aura but without any history of a pyogenic infectious process, who suffered status migrainosus as the sole manifestation of a brain abscess.
Headache 1999 Jan
PMID:Status migrainosus: an unusual presentation of a brain abscess. 1561 97

Free-living amebas in the genera Naegleria, Acanthamoeba and Balamuthia are known to cause CNS infections. Here we report a case of fatal granulomatous amebic meningoencephalitis (GAE) caused by Balamuthia mandrillaris in a 6-year-old previously healthy girl who presented with headache and stiff neck. She was treated medically for brain abscess after a CT scan identified a ring-enhancing lesion in the right temporo-parietal area. A brain biopsy showed necrosis and granulomatous inflammation. Subsequently, multiple new lesions appeared in the brain bilaterally. A second brain biopsy revealed viable amebic trophozoites that were most abundant in perivascular spaces, accompanied by neutrophils, macrophages and eosinophils. Immunofluorescence study confirmed the amoeba as Balamuthia mandrillaris. This case demonstrates that making diagnosis of GAE pre-mortem requires a high index of suspicion. Amebic infection should be included in the differential diagnosis of any granulomatous lesion in CNS; and careful search for amebic parasites should be carried out especially when necrosis predominates in the pathological material.
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PMID:September 2004: a 6-year-old girl with headache and stiff neck. 1577 45


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