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Based on the findings from angiograms done over a 4-year period in Zambia, the most common indications were cerebrovascular disorders, head injuries, infective lesions, epilepsy and intracranial tumours. A few patients were also investigated for headache and vomiting, visual symptoms and papilloedoma. The overall positive yield at 23% was high. 10% of the abnormalities were cerebrovascular lesions. (Occlusive disease and subdural haematoma were common; aneurysms, arteriosclerosis, epidural haematoma, arteriovenous malformations were rare.) Compared with western countries, tumours were not as common but brain abscess was encountered more frequently. Carotid angiography is a valuable tool in tropical neurological practice and the pattern of disease differs from the western countries.
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PMID:Cerebral angiography in Central Africa. 729 88

The effect of consanguinity on fertility, reproductive loss, and development disorders were studied in South India. The population investigated included 377 unselected mothers who, along with their children, were followed up longitudinally. Each mother was interviewed regarding consanguinity, details of reproductive performance, and death of any offspring. Marriages were classified as unrelated or between uncle and niece, between first cousins, between first cousins once removed, between second cousins, between second cousins once removed, and between third cousins. Among the 377 marriages, 156 (41.4%) were consanguineous and 221 (58.6%) were nonconsanguineous. Consanguinity was more prevalent among Hindus than among Muslims or Christians. The mean and standard deviation in the age of women were similar in all age categories at the time of the study, but the numbers of pregnancies and live births were higher in consanguineous than in nonconsanguineous unions. The mean number of living children were not significantly different in the 2 groups. Although the intrauterine wastage showed no significant difference between the 2 groups, extrauterine loss of life, especially the death rate of children, was higher in the consanguineous marriages. The causes of death in the nonconsanguineous group were diptheria, tuberculosis meningitis, acute nephritis, convulsive disorder, and brain abscess. The causes of death in the consanguineous group were measles with complications, gastroenteritis, pyogenic meningitis, whooping cough, convulsive disorder, undiagnosed fever, burns, and undiagnosed illness with persistent vomiting. In regard to developmental anomalies, in only 1 instance was the condition unequivocally due to autosomal recessive inheritance. In the majority of the remaining cases the disorders were polygenic or multifactorial in origin. The frequency of developmental anomalies was significantly more frequent among the children of consanguineous parents.
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PMID:Reproductive wastage and developmental disorders in relation to consanguinity in south India. 731 41

A case of gas-producing brain abscess with subdural abscess was reported. An 18-year-old boy was admitted with a five-day history of vomiting and high grade pyrexia. Plain skull roentgenograms demonstrated left frontal multiple gas bubbles. CT scan and MRI showed that both brain and subdural abscesses contained gas in the left frontal area. Antibiotics and glyceol were intravenously administrated. In serial CT scans, subdural abscess was not recognized, while brain abscess was enhanced in a ring. Seven days after admission, milky white pus with a fecal odor was aspirated using CT guided stereotactic apparatus, and the catheter was left in the abscess cavity. Culture of the pus grew peptostreptococcus. On the 22nd hospital day, repeated aspiration and drainage were performed for the residual brain abscess. The patient gradually improved after the aspiration with continuous administration of antibiotics, and he was discharged on the 59th hospital day with no neurological deficits. Based on our experience and a review of the literature, the treatment of choice is aspiration in the late cerebritis stage of brain abscess.
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PMID:[A case of gas-producing brain abscess with subdural empyema: timing of the operation for brain abscess]. 747 5

We report two patients with solitary thalamic abscesses, occurring among 91 consecutive patients (2.2%) with computed tomography (CT)-diagnosed and surgically-verified brain abscess experienced in our college during 1975 to 1991. A 9-year-old girl with congenital heart disease experienced frequent vomiting followed by left hemiparesis and deterioration of consciousness. CT demonstrated a right thalamic ring-enhanced lesion. Purulent material was aspirated via a burr hole. She died of heart failure on the 5th postoperative day. Autopsy disclosed diffuse brain swelling and an encapsulated abscess in the right thalamus, which had ruptured into the third ventricle. A 30-year-old female experienced headache, nausea, and vomiting, which progressed to somnolence and right hemiparesis. CT demonstrated a left thalamic ring-enhanced lesion. Purulent material was aspirated by stereotactic procedures. All symptoms had resolved by the end of the 2nd postoperative week.
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PMID:Solitary pyogenic thalamic abscess--two case reports. 750 3

The number of brain abscesses has been reduced since the preantibiotic era. This was accomplished by judicious use of antibiotics, by the advent of computed tomography, and by improvements in patient care and surgical techniques. Analysis from 122 patients with brain abscess demonstrated this trend of progress. Our series had a 3.2-to-1 male predominance. The underlying conditions included otolaryngologic infections (26 cases), cyanotic heart diseases (27 cases), implantation abscess (25 cases), lung infections (5 cases), meningitis (4 cases), osteomyelitis (2 cases), decreased immunity from chronic systemic diseases (12 cases), and unknown causes (21 cases). Otolaryngologic subgroups can be detailed as chronic otitis media with cholesteatoma (15 cases), chronic otitis media with mastoiditis (4 cases), sinusitis (2 cases), esophageal stenosis (3 cases), cheek cellulitis (1 case), and nasopharyngeal carcinoma (1 case). The initial symptoms and signs were headache (46 cases), fever (36 cases), altered consciousness (30 cases), neurologic deficits (33 cases), vomiting (11 cases), and seizure (17 cases). Of the brain abscesses treated, multiple brain abscess represented 16.4% of all cases. The overall percentage of patients with full recovery was 52.5%, whereas 84.8% of otolaryngologic subgroup recovered fully. The overall mortality was 19.7%. The mortality rate of brain abscess from otolaryngologic sources was 3.8%, whereas that from nonotolaryngologic sources was 24%.
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PMID:Brain abscess: with special reference to otolaryngologic sources of infection. 760 12

The patient was a 26-year-old man who complained of headache and vomiting. On examination, there was nothing abnormal, but the edge of the right optic papilla was not clear. His temperature was 38.5 degrees C, pulse 96/min, blood pressure 120/80 mmHg. A space-occupying lesion in his fronto-dextra cupular part was found by CT scanning. He had a 12-year history of chronic purulent otitis. The diagnosis was a brain abscess in the fronto-dextra cupular part. The brain abscess was extracted and Pasteurella multocida was isolated from the dark brown pus draining from the abscess. The patient recovered through proper antibiotic therapy based on a sensitivity test. Reports of infections caused by this organism in foreign countries very widely from local infections due to bites and scratches by cats, dogs etc. to general infections such as infections of the respiratory tract, sepsis and meningitis. However, Pasteurella multocida brain abscesses are rare. Pasteurella multocida is a Gram-negative short rod which is best known as part of the mouth flora and as a pathogen causing septicemia in many domestic animals, such as cats, dogs etc.. Infection in man results mainly from animal bites or scratches. It has been reported that Pasteurella multodida can cause human septicemia, meningitis, respiratory tract infection, conjunctivitis and other infections. We isolated a strain of Pasteurella multocida from the pus of a brain abscess following chronic purulent otitis on August 6, 1990.
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PMID:Brain abscess due to Pasteurella multocida. 817 82

A case is reported here of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas. A 19-year-old male who had been diagnosed in 1988 as pulmonary arteriovenous fistulas was admitted to our hospital for repeated epistaxis, headache, and vomiting. A brain abscess which was diagnosed using various roentogenologic examinations, worsened despite conservative therapy. Additional surgical drainage was performed; S. sanguis was isolated from the drainage fluid. After drainage, clinical symptoms gradually improved with no subsequent neurological deficits. We have formulated the following hypothesis regarding the mechanism of abscess formation in this case: S. sanguis invaded from a ruptured nasomucosal vein, forming a septic emboli in the blood flow, which passed through a pulmonary arteriovenous shunt and led to the formation of a brain abscess which established a metastatic presence in the cerebral tissue.
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PMID:[A case of brain abscess due to Streptococcus sanguis in association with multiple pulmonary arteriovenous fistulas]. 836 May 24

Sixty-seven patients with brain abscess were managed over 19 years (1975-1993). Our series had a 2.5 to 1 male predominance; the age distribution was from 3 days to 81 years. The underlying conditions of hematogenic brain abscesses (n = 33; 49%) included lung infections (n = 16), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Otolaryngologic infections led to the abscess in 10 cases; there were 9 traumatic abscesses. The causes remained unknown in 15 cases. There were 47 solitary abscesses (70%) and 20 multiple abscesses. The most frequent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headaches, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The most reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspiration of the abscess with or without drainage was possible in 30 cases; the mortality in this subgroup was 9%. All 4 patients with surgical excision in the pre CT-era died. The mortality of patients treated with antibiotics only was 62% (18/29). Overall mortality was 37% (25/67), including 5 cases with post mortem-diagnosis of brain abscess. Good recovery was achieved in 29/42 survivors. Predictors of a poor outcome were the patient's age, the level of consciousness, multiple abscesses, polybacterial cultures, and a hematogenic etiology, but not the size of the abscess.
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PMID:[Bacterial brain abscess--experiences with 67 patients]. 880 80

We present a case with brain abscess associated with entrapment of the lateral ventricle appearing more like remarkable brain edema in the temporo-occipital lobe than ventricular dilatation. A 72-year-old man suffering from headache and vomiting visited our clinic. CT and MRI showed brain abscess in the right parieto-occipital lobe, associated with ventriculitis. Lumbar puncture also revealed purulent meningitis. Both symptoms and CSF findings improved after administration of antibiotics. The improved condition continued for two months after admission, but disturbed consciousness and left hemiparesis than appeared. MRI and CT showed entrapment of the lateral ventricle and brain edema of the right temporo-occipital region without ventricular dilatation. Because brain edema was thought to be caused by transudate of the CSF through the ventricular wall, lobectomy of the right temporal lobe and opening of the temporal horn were carried out. Although left hemiparesis and disturbed consciousness and brain edema disappeared after the operation, subdural effusion appeared. Using a subdural-peritoneal shunt, the subdural effusion was prevented and disappeared. In this case, we thought Hounsfield Unit (HU) of the brain edema caused by transudate of CSF through the ventricular wall (12.6) was markedly lower than that of so-called vasogenic edema (25.1) due to active inflammation. Measurement of the HU seemed to be a useful means to differentiate the types of brain edema in this situation from that of vasogenic edema caused by brain abscess, and thus a means for selection of the appropriate treatment.
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PMID:[Brain abscess and ventriculitis associated with entrapment of the lateral ventricle appearing more like remarkable brain edema than ventricular dilatation--a case report]. 1126 Aug 92

A 16-year-old adolescent presented with fever, lethargy and vomiting associated with mild dehydration. This was followed less than 24-hours later by loss of consciousness, seizures and clinical brain death. She had no prior medical illness, no hospital or frequent antibiotic exposure. There was no evidence of soft tissue or skin infection. Management included intravenous fluids, ampicillin and cefotaxime parenterally, dexamethasone, endotracheal intubation and mechanical ventilation. Her neurologic examination remained unchanged with areflexia, flaccid paralysis and fixed pupils. Post-mortem examination revealed an eight-centimetre right fronto-parietal lobe brain abscess. Cultures were positive for methicillin resistant Staphylococcus aureus. Although formerly a nosocomial pathogen affecting debilitated patients in the hospital setting, S aureus that is methicillin resistant is emerging as a community acquired pathogen affecting previously well patients.
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PMID:A fatal case of community acquired methicillin resistant Staphylococcus aureus brain abscess in a previously healthy adolescent. 1708 7


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