Lee Cha Gon, Kang Seong Hun, Kim Yae Jean, Shin Hyung Jin, Choi Hyun Shin, Lee Jee Hun, Lee Mun Hyang
Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
Korean J Pediatr. 2010 May;53(5):648-52. doi: 10.3345/kjp.2010.53.5.648. Epub 2010 May 31.
A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses.
A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea.
Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied.
Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.
脑脓肿是中枢神经系统的一种严重疾病。我们开展本研究以总结脑脓肿的临床表现及转归。
对1994年11月至2009年6月在韩国首尔三星医疗中心诊断为脑脓肿的儿科患者进行回顾性病历审查。
本研究纳入25例患者。平均每年确诊1.67例，中位年龄为4.3岁。常见的临床表现为发热（18/25，72%）、癫痫发作（12/25，48%）、精神状态改变（11/25，44%）以及颅内压升高体征（9/25，36%）。共有14例（56%）患者有基础疾病，其中先天性心脏病最为常见（8/25，32%）。15例（60%）患者确定了易感因素。常见的易感因素为耳源性感染（3/25，12%）和穿透性头部外伤（3/25，12%）。64%的患者（16/25）确定了致病微生物。病原体为中间型链球菌（n = 3）、金黄色葡萄球菌（n = 3）、肺炎链球菌（n = 1）、B组链球菌（n = 2）、大肠杆菌（n = 1）、铜绿假单胞菌（n = 1）以及疑似真菌感染（n = 5）。7例患者仅接受药物治疗，而其他18例患者还需要手术干预。总体死亡率为16%，20%的患者有神经后遗症。转归与所研究因素之间无统计学关联。
尽管脑脓肿并不常见，但却是一种严重疾病。高度怀疑对于早期诊断和预防严重后果非常重要。
