Ratanasiri B
Department of Medical Services, Children's Hospital, Bangkok, Thailand.
J Med Assoc Thai. 1995 Jan;78(1):37-41.
Brain abscesses are the most common form of intracranial suppurative process in children. In ten years, 54 cases of brain abscess in the Children's Hospital, Bangkok were diagnosed mostly on the basis of clinical features, roentgenogram, CT scanning and basic laboratory findings. The age distribution of brain abscess was from 3 months to 14 years. Evidence of signs of increased ICP was frequently present. Almost half of the patients had associated congenital heart disease particularly Tetralogy of Fallot. CT scanning was very useful in the advantage of rapid diagnosis, early management and short and long-term follow-up, by decreasing the mortality of the patients. Definite diagnosis must be established by obtaining pus or infected ncrotic brain for culture. Brain abscess bacteria can be recovered from properly performed culture. In our series, anaerobic peptostreptococci was the organism most frequently encountered. In the present series, the mortality rates for antibiotic alone and for antibiotic plus aspiration or followed by excision showed no significant difference. Most of deaths were due to brain herniation. It is concluded that with earlier diagnosis, with CT scanning technology, with appropriate antibiotics and with the use of proper surgical methods, the mortality rate from brain abscess should be zero and neurological deficit should be reduced as well.
脑脓肿是儿童颅内化脓性病变最常见的形式。在十年间，曼谷儿童医院诊断出54例脑脓肿病例，大多是根据临床特征、X线片、CT扫描及基本实验室检查结果做出诊断的。脑脓肿患者的年龄分布为3个月至14岁。经常出现颅内压升高的迹象。几乎一半的患者伴有先天性心脏病，尤其是法洛四联症。CT扫描在快速诊断、早期治疗以及短期和长期随访方面非常有用，可降低患者死亡率。必须通过获取脓液或感染的坏死脑组织进行培养来明确诊断。通过正确的培养可分离出脑脓肿细菌。在我们的病例系列中，厌氧消化链球菌是最常遇到的病原体。在本病例系列中，单纯使用抗生素治疗与抗生素加穿刺抽吸或随后切除治疗的死亡率无显著差异。大多数死亡是由于脑疝。结论是，通过早期诊断、CT扫描技术、适当的抗生素以及正确的手术方法，脑脓肿的死亡率应降为零，神经功能缺损也应减少。
