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Brain abscesses in the young
Insights
Brain abscesses are rare in children, often linked to congenital heart disease. Surgical drainage and antimicrobial therapy are crucial, but significant morbidity and mortality persist.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Brain abscesses in pediatric populations are infrequent, with only 14 cases documented at Texas Children's Hospital since 1968.
- Congenital heart disease was the most common predisposing factor, identified in five patients.
Observation:
- Three cases involving sinusitis and mastoiditis as precipitating factors were analyzed in detail.
- Clinical presentations frequently included signs of increased intracranial pressure (64% of patients).
Findings:
- Surgical drainage was performed in all cases, with some requiring repeated procedures.
- Bacteriologic analysis revealed a mix of anaerobic (43%) and aerobic (36%) organisms, with polymicrobial infections in 14% of cases.
- Despite antimicrobial therapy and surgical intervention, mortality was 21%, and residual neurological deficits occurred in one patient.
Implications:
- This study highlights the challenges in managing pediatric brain abscesses, emphasizing the need for prompt diagnosis and intervention.
- The persistent significant morbidity and mortality underscore the importance of further research into optimal treatment strategies and preventative measures.
Abstract:
Brain abscesses in the young are rare. Only 14 such abscesses have been seen at Texas Children's Hospital since 1968. Most abscesses developed in association with congenital heart disease (5), although sinusitis and mastoiditis were precipitating causes in two patients and one patient, respectively. The latter three patients' cases are reviewed in detail. Clinical and bacteriologic findings in all patients are discussed. There were signs of increased intracranial pressure in nine patients (64%). All abscesses were drained; in several, repeated drainage was necessary. Anaerobic organisms were recovered in six patients (43%), aerobic organisms were recovered in five (36%), and both were recovered in two (14%). In one patient no growth was reported. Antimicrobial therapy was administered to all patients but one, whose abscess was completely excised. Morbidity and mortality remained significant: three patients (21%) died and one has a residual hemiparesis.