Clinical features, microbiology, and management of pediatric brainstem abscess
- PDF / 1,428,418 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 70 Downloads / 178 Views
CASE-BASED REVIEW
Clinical features, microbiology, and management of pediatric brainstem abscess Łukasz Antkowiak 1
&
Monika Putz 1 & Marek Mandera 1
Received: 4 May 2020 / Accepted: 23 July 2020 # The Author(s) 2020
Abstract Purpose Brainstem abscess is a rare condition accounting for merely 1% of brain abscesses incidence in the pediatric population. This study aimed to present a single patient with a pontine abscess and review the literature to highlight clinical features, diagnosis, and management of brainstem abscess. Methods The PubMed database was screened for English-language articles concerning pediatric brainstem abscess. We, therefore, identified 22 publications, which concisely depict 23 cases. Our study reports on the 24th pediatric patient diagnosed with that entity. All included reports were analyzed in terms of clinical presentation, diagnosis, management, and outcomes of described patients. Results There was slight women predominance (15:9), with a mean age of occurrence 6.4 years, ranging from 7 months to 16 years. Pons was the most common location of brainstem abscess, occurring in 75% of patients. Clinically, they mostly presented with cranial nerves palsy (79.2%), hemiparesis (66.7%), and pyramidal signs (45.8%). The classic triad of symptoms, including fever, headache, and the focal neurologic deficit was present in 20.8% of patients. Positive pus cultures were obtained in 61.1%. Streptococci and Staphylococci were the most frequently identified pus microorganisms. Outcomes were satisfactory, with a 79.2% rate of general improvement. Conclusions Neurosurgical aspiration is a safe and beneficial therapeutic method. It should always be considered and should promptly be performed when the conservative treatment is not successful and clinical deterioration occurs. Prognosis in pediatric brainstem abscess is generally favorable. Most patients recover with minor neurologic deficits or improve completely. Keywords Brainstem abscess . Streptococcus intermedius . Management . Diagnosis
Introduction Brain abscess is defined as a collection of pus in the brain parenchyma. It appears typically in a devitalized area or affected by poor microcirculation [1]. Its incidence is estimated between 0.4 and 0.9 per 100,000 people per year [2]. Nathoo et al. report that 42% of brain abscesses appear in the pediatric population [3]. Their typical location includes frontal, * Marek Mandera [email protected] Łukasz Antkowiak [email protected] Monika Putz [email protected] 1
Department of Pediatric Neurosurgery, Medical University of Silesia, Ul. Medyków 16, 40-752 Katowice, Poland
temporal, parietal lobes, and cerebellum. Merely 1% of all brain abscesses are found within the brainstem [4, 5]. To date, 23 childhood brainstem abscesses were described in the literature, and we report on the 24th case [5–26]. Typical triad of symptoms, including fever, headache, and the focal neurologic deficit, is being found in merely up to 28% of patients diagnosed with brain abscess [27]. Clinical presentatio
Data Loading...
