Teferi Nahom, Chowdhury Ajmain, Lee Sarah, Challa Meron, Weiner Lukasz, Auerbach Sarah, Rao Mahil, Dlouhy Brian J
1Department of Neurosurgery, University of Iowa, Iowa City, Iowa.
2University of Iowa, Carver College of Medicine, Iowa City, Iowa.
J Neurosurg Case Lessons. 2023 Aug 7;6(6). doi: 10.3171/CASE23262.
Pediatric brainstem abscesses are rare entities that account for 1% of all brain abscesses and, when diagnosed, constitute a neurosurgical emergency.
A previously healthy 11-year-old male presented with several days of worsening headache, confusion, and ataxia. Brain magnetic resonance imaging (MRI) revealed a midbrain and pons lesion. The patient subsequently had a rapid neurological decline with loss of consciousness and brainstem function. Follow-up MRI revealed significant enlargement of the brainstem lesion with extension into the pons, midbrain, and thalamus, with greater concerns for an abscess rather than a tumor or an inflammatory process. He was taken for an emergent stereotactic aspiration of the abscess, and broad-spectrum antibiotics were initiated. He had neurological improvement, which subsequently declined 5 days later with brain MRI revealing an increase in the brainstem abscess, which required a second stereotactic aspiration. After rehabilitation, he made a significant neurological recovery.
Pediatric brainstem abscesses are rare pathologies, and a high index of suspicion is needed in patients presenting with a brainstem lesion mimicking tumor but with rapid neurological decline despite no other evidence of infection or infectious/inflammatory markers. Stereotactic aspiration is required for large lesions to target the antibiotic treatment and as an adjunct to broad-spectrum antibiotics.
小儿脑干脓肿是罕见疾病，占所有脑脓肿的1%，一旦确诊，即构成神经外科急症。
一名此前健康的11岁男性，出现数天来逐渐加重的头痛、意识模糊和共济失调。脑部磁共振成像（MRI）显示中脑和脑桥有病变。该患者随后出现快速的神经功能衰退，意识丧失和脑干功能丧失。随访MRI显示脑干病变显著扩大，延伸至脑桥、中脑和丘脑，更令人担忧的是脓肿而非肿瘤或炎症过程。他接受了紧急立体定向脓肿穿刺抽吸，并开始使用广谱抗生素。他的神经功能有所改善，但5天后病情再次恶化，脑部MRI显示脑干脓肿增大，需要进行第二次立体定向抽吸。经过康复治疗，他的神经功能有了显著恢复。
小儿脑干脓肿是罕见的病理情况，对于表现为类似肿瘤的脑干病变但尽管没有其他感染或感染/炎症标志物证据却出现快速神经功能衰退的患者，需要高度怀疑。对于大的病变，需要进行立体定向抽吸以指导抗生素治疗，并作为广谱抗生素的辅助手段。
