Department of Surgery, Neurosurgery, College of Health Medicine, Makerere University, Mulago Upper Hill, Kampala, Uganda.
Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
J Med Case Rep. 2024 Mar 28;18(1):183. doi: 10.1186/s13256-024-04451-0.
Brain abscesses are rare but potentially fatal condition and can be associated with cyanotic congenital heart disease of which 5-18.7% of these patients that develop cerebral abscess commonly have tetralogy of Fallot (TOF).
We report a case of 3-year-old Muganda male that presented with convulsions, cyanosis and difficulty in breathing. The patient had a combination intervention of medical treatment and surgical drainage of the abscess. Post-operative Computerized tomography scan images and pre-operative brain Computerized tomography scans were compared. The multiple rings enhancing lesions were reduced in number and sizes. The largest measured ring was 44 × 22.5×16mm compared to the previous; 42 × 41×36mm. The mass effect had reduced from 16 mm to 7.5 mm. The periventricular hypodensities persisted. Findings showed radiological improvement with residual abscesses, subacute subdural hematoma and pneumocranium. The patient was treated with intravenous ceftriaxone 1 g OD for six weeks and he showed marked improvement and was discharged home after 3 months.
A comprehensive strategy involving medications, surgical drainage, and early neurosurgical consultation is vital in treating brain abscesses in uncorrected TOF. Early identification of the pathogen, appropriate antibiotic therapy, and vigilant follow-up through clinical assessments and imaging are crucial, potentially spanning a 4-8-week treatment.
脑脓肿是一种罕见但潜在致命的疾病，可能与发绀型先天性心脏病有关，其中 5-18.7%的此类患者会发展为法洛四联症（TOF）。
我们报告了一例 3 岁的 Muganda 男性患者，他出现抽搐、发绀和呼吸困难。该患者接受了药物治疗和脓肿引流的联合干预。对比了术后计算机断层扫描图像和术前脑计算机断层扫描。多发环形增强病变的数量和大小减少。最大的测量环为 44×22.5×16mm，而之前为 42×41×36mm。肿块效应从 16mm 减少到 7.5mm。脑室周围的低信号密度仍然存在。结果显示，残余脓肿、亚急性硬脑膜下血肿和气颅存在，存在影像学改善。该患者接受了静脉注射头孢曲松钠 1g 每日一次治疗六周，表现出明显改善，并在 3 个月后出院回家。
在未经矫正的 TOF 患者中，涉及药物治疗、手术引流和早期神经外科咨询的综合策略至关重要。早期识别病原体、适当的抗生素治疗以及通过临床评估和影像学进行的警惕性随访至关重要，治疗可能持续 4-8 周。
