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Postcraniotomy gas-containing brain abscess: a neurosurgical emergency. Case report
J E Cohen1, R Mierez, E C Tsai
1Departmento de Neurocirugía, Hospital de Emergencias Dr. Clemente Alvarez, Universidad Nacional de Rosario, Argentina.
Background:
Gas-containing brain abscesses are very rare, and the majority are caused by Clostridium perfringens. We report a case of gas-containing brain abscess that required urgent surgery after a craniotomy for a brain tumor.
Methods And Results:
The patient was a 53-year-old male who presented with a cerebral neoplasm. A temporal lobectomy was performed and the diagnosis of low grade glioma was confirmed. Although the surgery was uneventful the postoperative course was complicated; the patient became agitated and febrile and deteriorated to a deep coma. A computed tomography scan demonstrated gas in the temporal fossa at the lobectomy site, producing mass effect. Urgent surgical debridement and drainage was performed and C. perfringens and mixed flora were found. Antibiotics were started and the patient's condition markedly improved. He was awake and alert, followed commands adequately and was extubated; however, after a week he suffered massive gastrointestinal bleeding and died.
Conclusions:
Early recognition of a gas-containing brain abscess is of great interest to immediately start the appropriate treatment. Urgent surgical debridement and broad spectrum chemotherapy are major components in the management of this entity.
Insights
Gas-containing brain abscesses, often caused by Clostridium perfringens, are rare. This case highlights the need for prompt surgical intervention and antibiotics for effective management.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Gas-containing brain abscesses are exceptionally rare, with Clostridium perfringens being the most common causative agent.
- This case involves a gas-containing brain abscess developing post-craniotomy for a brain tumor.
Observation:
- A 53-year-old male with a low-grade glioma underwent a temporal lobectomy.
- Postoperatively, the patient developed agitation, fever, and coma, with CT scans revealing gas in the temporal fossa.
Findings:
- Urgent surgical debridement and drainage identified Clostridium perfringens and mixed flora.
- The patient initially improved with antibiotics but later succumbed to gastrointestinal bleeding.
Implications:
- Early detection and immediate treatment, including surgical debridement and broad-spectrum antibiotics, are crucial for managing gas-containing brain abscesses.
- This case underscores the importance of vigilant postoperative monitoring for rare complications like brain abscesses.