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Brain abscess in childhood--long-term experiences
C Aebi1, F Kaufmann, U B Schaad
1Department of Paediatrics, University of Berne, Inselspital, Switzerland.
Insights
Paediatric brain abscess treatment has evolved, with CT scans significantly reducing diagnostic delays and mortality. Surgical excision is linked to worse outcomes, favoring antibiotics and needle aspiration.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Paediatric brain abscesses are rare but serious infections.
- Historically, predisposing factors included congenital heart disease, sinusitis, otitis media, mastoiditis, and immunodeficiency.
- Non-specific symptoms often delayed diagnosis and treatment.
Purpose of the Study:
- To evaluate treatment outcomes for paediatric brain abscesses.
- To assess the impact of diagnostic imaging, specifically CT scans, on patient outcomes.
- To compare the long-term sequelae associated with different surgical interventions.
Main Methods:
- Retrospective analysis of 28 paediatric brain abscess cases diagnosed between 1967 and 1987.
- Review of predisposing factors, clinical presentation, diagnostic methods, and treatment approaches.
- Long-term follow-up assessments including neurological examinations, EEG, and psychological testing.
Main Results:
- CT availability reduced diagnostic delay from 8.4 to 3.0 days and mortality from 23% to 0%.
- Long-term sequelae included neurological deficits (35%), epilepsy (29%), and CNS scars (50%).
- Surgical excision was associated with higher rates of CNS scars and epilepsy compared to aspiration and antibiotics.
Conclusions:
- CT scans have dramatically improved paediatric brain abscess management.
- Surgical excision of brain abscesses should be avoided due to increased long-term complications.
- Optimal treatment involves antibiotics, potentially with CT-guided needle aspiration.
Abstract:
A retrospective evaluation was performed on 28 cases of paediatric brain abscess (male: female ratio 2.5:1; mean age 9.4 years; range 2.8-16 years) diagnosed between 1967 and 1987. In 46%, congenital cyanotic heart disease was identified as a predisposing factor, likewise sinusitis, otitis media or mastoiditis in 29% and immunodeficiency in 11%. Pathogenesis remained unclear in 14%. Initial symptoms and signs were predominantly nonspecific; loss of consciousness occurred in 32% of cases, neurological deficit and seizures each in 25%. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8.4 to 3.0 days, and mortality from 23% to 0%. Seventeen patients (61%) had follow up examinations 9.6 years (mean) after the acute illness (range 1-21 years). Neurological sequelae were diagnosed in 35% of cases, epilepsy in 29%, epileptic potentials during EEG in 12%, and CNS scars in 50%. Psychological testing revealed no statistically significant differences compared to normal populations. CNS scars, and epilepsy and/or epileptic potentials were more common after excision (7 patients) when compared to patients treated by aspiration and/or antibiotics alone (21 patients). It is concluded that excision of brain abscess should be avoided whenever possible. Therapy of choice consists of the administration of adequate antibiotics with or without CT-guided needle aspirations.