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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients with hematogenous brain abscesses demonstrated by computerized tomographic (CT) scans were successfully treated without surgical intervention. The first patient had congenital cyanotic heart disease and multiple brain abscesses complicated by presumed rupture into the ventricles. By the time these clinical diagnoses were established, she had shown substantial improvement after antibiotic therapy alone. The second patient with bronchiectasis had a single abscess in the dominant hemisphere. Medical management was successful. Subsequent CT scans in both patients provided reassurance that clinical improvement was accompanied by anatomical healing. The use of noninvasive diagnostic techniques should encourage the formulation of new criteria for the management of cerebral abscess in carefully evaluated and closely observed patients.
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PMID:Use of computerized tomography in nonsurgical management of brain abscess. 42 May 98

Twenty-two cases of sub-tentorium cerebral abscesses were observed in children. The first clinical symptoms were those of intracranial hypertension, disorders of consciousness, specially somnolence, fever and low general condition. Focal neurological signs were frequent but appeared later. A cerebral abscess should be suspected when such symptoms occur in children with heart disease or with respiratory infection. Simple investigations like examination of the fundi, X-ray of the skull and EEG give valuable clues. In case of such a clinical picture, lumbar puncture is useless and often dangerous. The best diagnostic test is a cerebral scintigram.
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PMID:[Sub-tentorial cerebral abscesses in children; a report of 22 cases]. 66 21

Fifty-four consecutive cases of children with cerebral abscess from 1958 to 1987 are reviewed. Their average age was 6.6 years, ranging from 3 days to 19 years. A wide range of organisms and underlying diseases was encountered. The predominant mode of surgical therapy was craniotomy with resection of the abscess. Aspiration and craniotomy with drainage-evacuation were also employed in our series. No underlying disease was found in 10 (19%) of the children. Cyanotic heart disease (CHD) was present in 13 (24%) of the children. Four children had dental abscesses and 1 had otitis media. Seven (13%) children had abscesses secondary to hydrocephalus/shunt infections. Sinusitis and otitis accounted for 5 cases (9%). Four children (7%) had tuberculomas. One abscess was associated with a nasal dermal sinus and one was congenital. Fourteen (26%) patients had negative cultures. Fourteen (26%) abscesses contained streptococci of various types. Staphylococci were found in only 5 (9%) of the abscesses. The congenital abscess was caused by salmonella. Two abscesses (7%) were fungal. Both of these patients died. Six children (11%) were treated without surgical intervention. Three of them died. Forty-eight children had surgical intervention; 12 underwent aspiration, 14 underwent open evacuation of the abscess, and 22 had abscesses resected. Mortality in the aspiration group was twice that of the evacuation or resection group (17, 7 and 9%), respectively). The factor which correlated best with mortality was the patient's clinical status on admission. The advent of CT scan at our facility improved mortality by facilitating accurate diagnosis and surgical intervention. Overall mortality rates decreased from 31 to 5.7% and surgical mortality fell from 21 to 2.9%.
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PMID:Pediatric cerebral abscess. 327 49

Non-otogenic cerebral abscess is becoming relatively more frequent compared with otogenic. It arises in a setting of sepsis, trauma, or congenital heart disease. The onset presents a meningo-encephalitic picture, often with two stages, followed by epilepsy and/or a hemiparesis. The best investigations are an EEG and, probably, an isotope scan. The angiogram may be misleading as 40% may not have a midline shift. 'Acute localized non-suppurative encephalitis' seems to be more frequent than in the past. Antibiotics and aspiration appear to be the best treatment.
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PMID:Non-otogenic cerebral abscess. 414 39

Two patients with cyanotic congenital heart disease (CHD) and erythremia were seen for abrupt onset of focal neurologic deficits and/or seizure without signs of infection or increased intracranial pressure. Clinical features and initial computed tomography (CT) in both cases suggested stroke. Subsequent CT scans demonstrated cerebral abscess, proved at operation. Review of records of patients with CHD at the University of Rochester (NY) Medical Center from 1965 to 1981 disclosed 12 cases with brain abscess but only two cases with aseptic cerebral infarction. All but one patient with abscess were cyanotic. One third of patients with abscess had a clinical picture suggesting stroke. Clinical or radiologic features of half the cases indicated that cerebral infarction may have led to abscess formation. Diagnosis of brain abscess and immediate antibiotic therapy should be strongly considered in patients with cyanotic CHD who suffer a suspected cerebral infarction.
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PMID:Cyanotic congenital heart disease with suspected stroke. Should all patients receive antibiotics? 683 Apr 69

During the period 1935 to 1976 200 patients with cerebral abscess were referred to the University Clinic of Neurosurgery, Rigshospitalet, Copenhagen. Among them 48 were children (less than 15 years), i.e. 24%. Fourteen of the children had multiple abscesses. Ear-, nose- or throat infections were the source of infection in 42% of the cases. Seven of the children had congenital heart disease. The clinical manifestations are described. The risk of lumbar puncture in these patients is emphasized by the fact, that three of them incarcerated during the procedure. Changing neuroradiological methods, affording limited differential diagnostic accuracy, have now been replaced by computed tomography. The most common surgical methods were primary excision or aspiration. The overall mortality rate was 33%.
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PMID:Cerebral abscess in children. 687 31

Eighteen cyanotic congenital heart disease (CCHD) and 17 acyanotic congenital heart disease (ACHD) patients in the age range of 2 months to 10 years along with their age and nutrition matched controls were studied for bactericidal, chemotactic and phagocytic functions. Bactericidal and phagocytic functions were significantly depressed in CCHD (p < 0.001) as well as ACHD group (p < 0.001) compared with controls. Chemotactic function was not significantly affected in either. Arterial oxygen content (as a measure of hypoxia) was calculated for each patient and correlated with each immune parameter by univariate linear regression analysis. In CCHD patients linear correlation of borderline significance (p = 0.07) was found between arterial oxygen content and bactericidal activity, but no correlation could be established with phagocytic and chemotactic functions. No correlation was obtained between hematocrit and any of the immune parameters. In ACHD patients no correlations were obtained between the immune parameters and arterial oxygen content or hematocrit. Iron deficiency anemia, known to affect bactericidal function, did not seem to affect the immune parameters in CCHD and ACHD groups. Altered oxygen content of the blood owing to hypoxia in CCHD patients may be an important etiological factor in the genesis of bacteremia and cerebral abscess. The affection of immune functions in ACHD cannot be adequately explained.
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PMID:Polymorphonuclear leukocyte functions in children with cyanotic and acyanotic congenital heart disease. 813 80

A prospective study was carried out to determine the aetiology of cerebral abscess in relation to the primary source of infections. Seventy-five patients with cerebral abscess were included in the study in the period January 1985 to December 1988. More than half of the patients studied had single lesions and the overall most common sites were in the frontal and parietal regions. Chronic suppurative otitis media, cyanotic congenital heart diseases and meningitis were among the important predisposing conditions in these patients. Approximately 25% of the patients with cerebral abscesses had no documented antecedent infections. Pure cultures were found to be predominant (66.7%) and sterile cultures were obtained from 10 (13.3%) patients. Streptococci were isolated from 23 (30.7%) patients, the commonest species being Streptococcus milleri. Proteus sp, Pseudomonas aeruginosa, Pseudomonas putrifaciens and Bacteroides sp were almost exclusively found in cerebral abscesses secondary to chronic suppurative otitis media; these organisms were found in mixed cultures. Streptococcus milleri, Bacteroides sp and Eikenella corrodens were found in pure cultures in patients with cyanotic congenital heart disease. In patients with ventriculoperitoneal shunts in-situ, Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids were common. Anaerobes were found in 15 (20.0%) patients, the majority in mixed cultures. Culture, as well as gas-liquid chromatographic analysis of volatile fatty acids of cerebral pus, was carried out to enhance the detection of the anaerobes. Based on these findings, an antibiotic regimen consisting of penicillin, chloramphenicol and metronidazole is recommended as an initial therapy while awaiting culture and sensitivity results.
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PMID:Microbiology of cerebral abscess: a four-year study in Malaysia. 850 76

Brain abscesses are classical complications of congenital heart disease (CHD) in children and adolescents. This association is rarely observed in adults. We report a 46-year-old man presenting a fronto-parietal abscess associated with an asymptomatic atrial septal defect. Positron emission tomography (PET) study revealed high uptake of L-[methyl-11C]methionine ([11C]methionine) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) around the brain abscess. We suggest (1) to exclude a silent cardiac malformation in the presence of a cerebral abscess of unknown source occurring in adults; (2) to consider the diagnosis of brain abscess in cases of high uptake of [11C]methionine and FDG in relation to a brain lesion.
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PMID:PET findings in a brain abscess associated with a silent atrial septal defect. 859 7

A previously healthy 40-year-old man experienced the sudden 'stroke-like' onset of homonymous hemianopsia due to a bacterial brain abscess. Clinical features and initial computed tomography (CT) suggested a stroke. Subsequent CT and magnetic resonance (MR) demonstrated a cerebral abscess, proven at surgery. It is extremely rare that a healthy individual without various risk factors, such as congenital heart disease, immunologic deficiency, diabetes mellitus, or pregnancy, presents with the above symptoms. The exact mechanism of this sudden 'stroke-like' onset in a patient with a bacterial brain abscess is unknown. One possibility is that paroxysmal septic emboli led to abscess formation within or near areas of embolic infarction. Another possibility is that a primary cerebral infarction was associated with secondary bacteremia. Surgical drainage revealed a bacterial (Streptococcus) abscess, but no identifiable source of infection.
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PMID:Sudden "stroke-like' onset of homonymous hemianopsia due to bacterial brain abscess. 898 24


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