Prasad Rajniti, Biswas John, Singh Kulwant, Mishra Om P, Singh Ankur
Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
Ann Indian Acad Neurol. 2020 May-Jun;23(3):303-307. doi: 10.4103/aian.AIAN_425_19. Epub 2020 Jun 10.
Brain abscess is a serious and dreadful disease presenting at tertiary centre. The objective of this study was to look into the clinical profile, predisposing conditions, microbiology and outcome of children suffering from brain abscess.
30 children up to 18 years with clinical and imaging evidence of brain abscess were taken for study. Patients were stabilized as per unit protocol. Necessary investigations were carried out. Neuroimaging (CT or MRI) was used to confirm the diagnosis. All parameters (clinical, investigation, outcome) were recorded in predesigned performa. Neurosurgery consultation was sought in patients with multiple abscesses, posterior fossa abscesses, abscess with air-fluid level and causing midline shift.
There were 16 males with 13 patients in age group (5-10 years). Mean duration of stay in hospital was 14.8 days. Most common predisposing factor was chronic suppurative otitis media (n-15). Typically, patients presented with fever, headache and seizures. On examination, motor deficits were the most common followed by signs of meningitis. Computerized tomography confirmed the diagnosis in most cases. Temporal lobe (n-11) was the commonest intracranial site for the abscess. and were the common pathogen isolated from blood and pus. Blood culture positivity rate was 16.7% and pus culture positivity rate was 25%. All cases were managed with intravenous antibiotics and aspiration (n-10) and excision (n-6). There were 5 deaths. There was complete immediate recovery in 13 cases with residual motor deficit in 12 cases.
Brain abscess is a rare but serious entity in children. Late diagnosis and improper management leads to poor outcome. Early surgical intervention is helpful. Threshold for diagnosis should be low in children with chronic ear infection and congenital heart diseases.
脑脓肿是一种在三级医疗中心出现的严重且可怕的疾病。本研究的目的是探讨患有脑脓肿的儿童的临床特征、诱发因素、微生物学及预后情况。
选取30名18岁以下有脑脓肿临床及影像学证据的儿童进行研究。患者按照科室方案进行病情稳定处理。进行了必要的检查。采用神经影像学检查（CT或MRI）来确诊。所有参数（临床、检查、预后）均记录在预先设计的表格中。对于有多发性脓肿、后颅窝脓肿、有气液平面的脓肿以及导致中线移位的患者，寻求神经外科会诊。
有16名男性，13名患者年龄在5至10岁年龄组。平均住院时间为14.8天。最常见的诱发因素是慢性化脓性中耳炎（n = 15）。通常，患者表现为发热、头痛和癫痫发作。检查时，运动功能障碍最为常见，其次是脑膜炎体征。计算机断层扫描在大多数病例中确诊。颞叶（n = 11）是脓肿最常见的颅内部位。[此处原文缺失两种病原体名称]是从血液和脓液中分离出的常见病原体。血培养阳性率为16.7%，脓液培养阳性率为25%。所有病例均采用静脉抗生素治疗，并进行了穿刺抽吸（n = 10）和切除（n = 6）。有5例死亡。13例患者立即完全康复，12例有残留运动功能障碍。
脑脓肿在儿童中是一种罕见但严重的疾病。诊断延迟和处理不当会导致不良预后。早期手术干预有帮助。对于患有慢性耳部感染和先天性心脏病的儿童，诊断阈值应较低。
