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

Cerebral abscess is a classical complication of cyanotic congenital heart disease. The authors report 7 cases of cerebral abscess diagnosed since 1982. One asymptomatic patient died of a postoperative cerebral haemorrage. The child was repatriated from Africa for complete correction of his cardiac lesion. The presentation of the other 6 cases was quite typical : headaches, pyrexia and vomiting with a neurological deficit in 4 cases : two hemiparesias and two homonymous lateral hemianopsia. These 6 patients recovered without sequeilae. Four underwent surgical drainage of the abscess with antibiotic therapy. Two recovered with antibiotic therapy alone. The causal organism was only identified in patients undergoing surgical drainage and then only in 3 cases. They were gram positive cocci, in particular the streptococcus. The association ampicillin-chloramphenicol has often been proposed as the treatment of first intention. Adaptation of antibiotic therapy then depends on clinical, biological, bacteriological (CSF, blood cultures, portal of entry) outcomes and the results of CT scanning. The association of a third generation cephalosporin and an imidazole may be proposed as treatment of second intention. The minimal duration of treatment is generally acknowledged to be 4 weeks for intravenous therapy in cases of medical therapy alone, and 2 to 3 weeks in cases with surgical drainage. The age of apparition of this complication seems to be increasing as the average age was 16 in this series (cerebral abscess is classically described as occurring between 8 and 12 years of age). This may be due to palliative surgery which reduces systemic hypoxia and polycythaemia. It also appears that neurological drainage is not systematic now because of early diagnosis of this complication. Finally, in the last few years, a new population of patients is becoming more common : patients repatriated by humanitary organisations in the third world, which should incite great vigilance in the preoperative period in this pathology.
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PMID:[Cerebral abscess and cyanotic congenital heart disease]. 929 46

Patients with cyanotic heart disease may have an acceptable quality of life but are exposed to several complications: polycythaemia, often beneficial but with its risks: hyperviscosity, hyperuricaemia, thrombocytopaenia, blood clotting abnormalities; and the other complications of right-to-left shunt: cerebral abscess, cerebral embolism, endocarditis. The hypoxia may be improved by interventional catheterisation or palliative surgery. The Eisenmenger syndrome is life-threatening in pregnancy or during general anaesthesia. These patients are at risk and sometimes have iatrogenic complications, so usual cardiological treatment may be dangerous: diuretics, ACE inhibitors, oral anticoagulants, antiarrhythmics.
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PMID:[Cyanotic heart disease in the adult]. 1250 Jun 32

Eisenmenger syndrome is the most common consequence of congenital cyanotic heart disease seen in adults; survival to the fifth decade of life is rare. Death is very difficult to predict: it is related to sudden cardiac ventricular arrhythmia, massive hemoptysis and right heart failure. In this paper, a patient with ventricular septal defect and Eisenmenger reaction is described. The patient was relatively well until 48 years of age, when she underwent surgery because of a cerebral abscess without cerebral complications but with some deterioration of her cardiac function. After discharge, the patient was readmitted to the hospital because the electrocardiogram showed persistent ST inferior elevation. Echocardiography demonstrated poor contractility and inferior akinesia. Sudden ventricular tachycardia occurred and the patient became unconscious. She was successfully resuscitated and, following a period of ventilation, the hemodynamics stabilized and she was discharged 17 days later. She remained well two years later.
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PMID:Eisenmenger syndrome: a case of survival after ventricular tachycardia due to inferior myocardial infarction in a 48-year-old patient with congenital large ventricular septal defect. 1522 66

In a 10-year-old boy presenting with focal seizures and 6 months later with acute right-sided hemiparesis, the diagnosis of a cerebral abscess due to Actinomyces israelii was established. The immunocompetent child suffered from a complex congenital heart disease with pulmonary arteriovenous shunts and pulmonary hypertension causing mild cyanosis. His parents had been reluctant to agree to neuroimaging investigations resulting in a delayed diagnosis. Despite the long interval between first symptoms and commencement of treatment including neurosurgical excision of the abscess followed by a 4-week course of ceftriaxone, a complete recovery of the hemiparesis was observed. This patient is the first case with cerebral actinomycosis before adolescence reported so far.
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PMID:Cerebral actinomycosis before adolescence. 1532 64

A 2-year-old boy with underlying congenital cyanotic heart disease presented with seizures and fever and was found to have bilateral parietal cerebral abscesses. Drainage of the pus from the abscesses was done in stages; on the day of admission, four days after admission and 3 weeks after admission. Although the pus from the first drainage did not grow any organisms, the pus from the second drainage on the fourth day of admission yielded a mixed growth of Eikenella corrodens and Streptococcus milleri. Following the second drainage of pus, the child was noted to have mild weakness (grade 3/5) and increased tone in the left upper limb. Three weeks after admission, due to recurring fever, further neurological signs and findings of an enlarging right cerebral abscess on a repeat CT scan, a third drainage was carried out. However no growth was obtained from this specimen. This patient was managed both surgically and with appropriate antibiotics. Over the next four months, serial CT scans revealed gradual resolution of the abscesses with disappearance of the surrounding oedema. The child showed gradual recovery of his left sided weakness with resolution of tone and reflexes to normal.
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PMID:Eikenella corrodens from a brain abscess. 1619 Jan 7

Forty cases of cerebral abscesses were studied prospectively to establish the microbial agents implicated in these cases. Chronic otitis media (14 patients, 35%), congenital heart disease (five patients, 12.5%),a and meningitis (five patients, 12.5%) were among the important predisposing factors. Streptococcus (14 patients, 35%) was the most common causative pre-isolated, the predominant species being Streptococcus milleri (11 patients, 27.5%). Other organisms isolated included Proteus mirabilis in six patients (15%) and Staphylococcus aureus in five patients (12.5%). Anaerobes (12 patients, 30%), predominantly Bacteroides sp. (eight patients, 20%), played an important role in these cases, the majority of which were isolated in mixed cultures. Gas-liquid chromatographic analysis of pus detected the presence of anaerobes in another 11 cases of cerebral abscess, in which cultures of anaerobes were negative. Therefore, gas-liquid chromotography is useful as an adjunct to conventional bacteriological methods in providing a rapid and sensitive means of detecting anaerobes in pus obtained especially from patients who had received antibiotic therapy prior to hospitalization.
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PMID:Use of gas liquid chromatography as an adjunct to conventional bacteriological methods in the diagnosis of anaerobic cerebral abscess. 1759 Jul 60

Cerebral abscess is a serious condition and in children the commonest cause is cyanotic congenital heart disease. We report a 12-year old male who presented with multiple brain abscesses. After an extensive evaluation including a transesphageal echocardiogram (TEE), we found a previously undiagnosed sinus venous atrial septal defect (ASD). He was treated medically with antibiotics. This is an unusual initial presentation of asymptomatic acynotic congenital heart disease in children. We recommended a complete cardiac evaluation including TEE with saline contrast study in the work up of an idiopathic cerebral abscess.
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PMID:Multiple brain abscesses: an initial presentation in a child with an undiagnosed sinus venosus atrial septal defect. 1760 Jun 15

In 5-10% of adults with congenital heart disease (left-to-right shunt defects), pulmonary arterial hypertension (PAH) can develop with variable severity. An extreme manifestation of PAH in this setting is known as the Eisenmenger syndrome. It represents not only PAH associated with congenital heart disease, but also a multi-systemic disorder, presented by variety of complications (cyanosis, bleeding, thrombotic diathesis, high risk of bacterial endocarditis or cerebral abscess, ischemic complications, hepatic and renal involvement, congestive heart failure and sudden death). Authors concisely identify the underlying pathophysiological and hemodynamic aspects of Eisenmenger syndrome and focus on the clinical presentation. Eisenmenger syndrome represents a unique form of PAH with many differences. The preserved right ventricular function seems to play the key role in a better survival of these patients compared to other forms of PAH. To achieve a satisfactory prognosis and life-quality in patients with Eisenmenger syndrome it is necessary not only to treat their hemodynamic features (PAH and/or ventricular dysfunction) but also to adequately manage and prevent all the multi-systemic complications resulting from this disease. This often needs a care in specialized centers with multi-disciplinary approach (Tab. 2, Fig. 6, Ref. 17).
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PMID:Eisenmenger syndrome--a unique form of pulmonary arterial hypertension. 2019 69

An immigrant from Romania was referred to the neurosurgical unit with a cerebral abscess. On examination she was cyanosed and had clubbing of her fingers. A cardiovascular system examination revealed a systolic murmur heard all over the precordium. However, the diagnosis was not congenital cyanotic heart disease. The patient had a history of frequent nosebleeds and had multiple telangiectases on her body, leading to the diagnosis of hereditary haemorrhagic telangiectasia (HHT). A search was carried out for the presence of arteriovenous malformations in internal organs. Large arteriovenous malformations were found in the lungs, causing her cyanosis due to right-to-left shunting of blood and cerebral abscess due to paradoxical septic embolisation into cerebral circulation.
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PMID:An interesting case of cerebral abscess. 2168 89

Infection of the central nervous system is a life-threatening condition in the pediatric population. Almost all agents can cause infection within the central nervous system and the extent of infection ranges from diffuse involvement of the meninges, brain, or the spinal cord to localized involvement presenting as a space-occupying lesion. Modern imaging techniques define the anatomic region infected, the evolution of the disease, and help in better management of these patients. Acute bacterial meningitis remains a major cause of mortality and long-term neurological disability. Fortunately, the incidence of infection after clean craniotomy is < 5%, but it leads to significant morbidity as well as fiscal loss. The most significant causative factor in postcraniotomy infections is postoperative CSF leak. Cerebral abscess related to organic congenital heart disease is one of the leading causes of morbidity and mortality in the pediatric population. The administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds.
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PMID:Central nervous system infection in the pediatric population. 2188 70


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