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Brain abscesses in children--a cooperative study of 83 cases
1Department of Pediatric Neurosurgery, Veterans General Hospital, Taipei, Taiwan.
Insights
This review of pediatric brain abscesses found that surgical intervention and aspiration improved patient outcomes. Prompt treatment of underlying conditions is crucial for survival in children with brain abscesses.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Brain abscesses in children are serious infections requiring prompt diagnosis and management.
- Congenital heart disease and sepsis/meningitis are significant comorbidities in pediatric brain abscess cases.
Purpose of the Study:
- To review the clinical experience with pediatric brain abscesses over a 10-year period.
- To analyze diagnostic methods, treatment strategies, and outcomes in children with brain abscesses.
Main Methods:
- Retrospective review of 83 pediatric brain abscess cases from seven teaching hospitals (1978-1987).
- Analysis of diagnostic data (CT brain scan), comorbidities, causative organisms, treatment modalities (antibiotics, surgery), and patient outcomes.
- Evaluation of surgical approaches including total excision, partial excision with aspiration, and aspiration alone.
Main Results:
- Computed Tomography (CT) brain scan detected 90.4% of brain abscesses.
- Common comorbidities included congenital heart disease (50.6%) and sepsis/meningitis (20.4%).
- Streptococcus was the most frequently isolated organism (49.2% of cultures). Overall survival was 59%, with 19.3% mortality. Better outcomes were observed with surgical excision/aspiration and in patients older than one year.
Conclusions:
- Surgical intervention, including total excision or aspiration, is associated with improved outcomes in pediatric brain abscesses.
- Aggressive management of underlying conditions contributing to brain abscesses is critical to reduce mortality.
- Early diagnosis and treatment, particularly in older children, can lead to better prognoses.
Abstract:
This study reviews our experience in 83 cases of brain abscesses in children diagnosed at seven teaching hospitals during the 10-year period from June 1978 to July 1987. The average age of the patients was 7 years, with 12% of them less than 1 year old. The male-to-female ratio was 1.7:1. Of the brain abscesses, 90.4% were detected by CT brain scan. A total of 50.6% patients had congenital heart disease, and 20.4% patients had sepsis and/or meningitis. Only 6% cases had ear, nose, and throat infection. Sixty-eight (81.9%) patients received a combination of antibiotics and surgical treatment. The cerebral abscesses were totally excised in 26 cases, aspirated and partially excised in 6, and aspirated in 32. Sixty patients had pus cultures from the cerebral abscesses. Organisms were isolated in 29 (49.2%) of them. Streptococcus was by far the most common organism. The overall outcome was: 49 (59%) alive; 16 (19.3%) dead; 18 (21.7%) lost to follow-up. Among the 16 mortalities, the causes of death were due to failure to treat the diseases causing the brain abscesses. We had a better outcome in patients whose cerebral abscesses were totally excised or whose abscesses were aspirated, and in patients who were older than 1 year of age.