Antkowiak Łukasz, Putz Monika, Mandera Marek
Department of Pediatric Neurosurgery, Medical University of Silesia, Ul. Medyków 16, 40-752, Katowice, Poland.
Childs Nerv Syst. 2020 Dec;36(12):2919-2926. doi: 10.1007/s00381-020-04835-9. Epub 2020 Jul 30.
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.
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.
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.
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.
脑干脓肿是一种罕见疾病，在儿童人群中仅占脑脓肿发病率的1%。本研究旨在报告一例患有脑桥脓肿的患者，并回顾文献以突出脑干脓肿的临床特征、诊断和治疗。
在PubMed数据库中筛选有关儿童脑干脓肿的英文文章。因此，我们确定了22篇出版物，简要描述了23例病例。我们的研究报告了第24例被诊断为此病的儿科患者。对所有纳入的报告从所描述患者的临床表现、诊断、治疗和结果方面进行了分析。
女性略占优势（15:9），平均发病年龄为6.4岁，范围从7个月至16岁。脑桥是脑干脓肿最常见的部位，75%的患者发生于此。临床上，他们大多表现为脑神经麻痹（79.2%）、偏瘫（66.7%）和锥体束征（45.8%）。20.8%的患者出现包括发热、头痛和局灶性神经功能缺损在内的典型三联征症状。61.1%的患者脓液培养呈阳性。链球菌和葡萄球菌是最常鉴定出的脓液微生物。结果令人满意，总体改善率为79.2%。
神经外科穿刺抽吸是一种安全有益的治疗方法。当保守治疗不成功且出现临床恶化时，应始终考虑并及时进行。儿童脑干脓肿的预后一般良好。大多数患者恢复后仅有轻微神经功能缺损或完全恢复。
