1/18. basilar artery vasculitis secondary to sphenoid sinusitis--case report.A 35-year-old male presented with basilar artery vasculitis secondary to sphenoid sinusitis manifesting as rapidly deteriorating symptoms including consciousness disturbance and right hemiparesis. Computed tomography (CT) on admission showed sphenoid sinusitis without intracranial lesion. Emergency angiography demonstrated basilar artery stenosis. The neurological deterioration was considered to be caused by ischemia of the perforating arteries branching from the stenotic portion of the basilar artery. The patient was treated with urokinase infusion through a microcatheter just proximal to the stenosis 3 hours after the onset of the symptoms. His consciousness level and right hemiparesis markedly improved immediately after the procedure. Magnetic resonance (MR) imaging on day 5 revealed that extension of the sphenoid sinusitis into the prepontine cistern had formed an abscess which was attached to the clivus. The basilar artery was embedded in the abscess at the angiographic stenosis. cerebrospinal fluid (CSF) analysis showed white blood cell count of 601/mm3 with 82% neutrophils, 89.2 mg/dl protein, and 31 mg/dl glucose. No causative organism in the CSF could be identified by smear or culture. Early MR imaging and CSF examination are recommended when patients present with both ischemic symptoms involving the basilar artery and opacification of the sphenoid sinus on CT to identify basilar artery vasculitis secondary to sphenoid sinusitis.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/18. Interhemispheric subdural empyema--case report.We report a case of interhemispheric subdural empyema following a meningoencephalitis. Ten days after the beginning of his illness a CT scan showed a left interhemispheric subdural empyema with a low density collection, a faintly enhancing rim, multiple very small cortical abscesses and brain edema. The empyema was successfully treated by the direct introduction of a catheter into the left interhemispheric subdural space via a single posterior frontal parasagittal burr hole, irrigation with saline, aspiration of the empyema, and removal of the catheter at the end of operation.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
3/18. brain abscess as a rare complication in a hemodialysed patient.BACKGROUND: Infections remain among the most common morbid events and are an important cause of death in end stage renal disease. They have reduced immune response and increased hazard of infections due to repeated puncture of an arterio-venous fistula, formation of haematoma at the site of cannulation and central vein catheterisation. CASE REPORT: We report a case of brain abscess in chronically haemodialysed patient admitted to our department due to haedache, vomiting, accelerated hypertension and fever. The clinical examination revealed narroving of the right palpebral slit, weeping and right oral angle hanging loose. He had mild microcytic anaemia and high level of g-globulin. Ophtalmologic examination showed normal oculi fundi. The computed tomography revealed heterogenous mass marginally enhanced with contrast agent in the right frontal cerebral lobe. The right fronto-temporal craniotomy was performed and the right frontal lobe abscess was found and totally excised. The postoperative course was uneventful besides of seizures which were effectively treated with carbamazepine. After bilateral nephrectomy the patient undervent succesfull kidney transplantation and is in good condition without any neurological defect. A probable cause of his brain abscess was peridontal abscess recognized 3 month earlier or bilateral vesicoureteral refluxes. CONCLUSIONS: 1. Uremic patients have a reduced immunocapacity and are a high risk group for infections of various etiology. 2. Prompt eradication of all sources of infection is essential in hemodialysed patients.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
4/18. Brain abscesses resulting from bacillus cereus and an Aspergillus-like mold.An 11-year-old boy with alveolar rhabdomyosarcoma of the thigh experienced three instances of catheter-related bacteremia resulting from After two episodes of seizures, two low-density lesions in the right parietal lobe and the left corpus callosum with enhanced pericavitary opacity were detected. The catheter was removed. A brain biopsy sample grew and revealed dichotomously branched septate hyphae compatible with The patient was treated with ceftriaxone and liposomal amphotericin b for 12 and 52 weeks, respectively, until biopsy-confirmed resolution of the infections.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
5/18. Latent abscess formation adjacent to a non-functioning intraventricular catheter.CASE REPORT: A 16-year-old male patient who had been treated at the age of 13 months with a ventriculoperitoneal (VP) shunt due to obstructive hydrocephalus was presented to our department for a routine follow-up examination. The patient had tolerated well a shunt disconnection in 1990 and the distal part had been removed. Six years later radiological evaluation revealed an intracerebral mass adjacent to the remaining intraventricular catheter. The mass, histologically classified as an abscess, had to be removed 3 years later due to disease progression, although the patient remained asymptomatic. DISCUSSION: This case is of particular interest because it demonstrates the extremely delayed onset and progressive course of a well-known complication of VP shunt systems in an asymptomatic patient. In addition, the reported case raises the question of whether a non-functioning shunt needs to be removed or not.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
6/18. Continual intracavitary administration of amphotericin b as an adjunct in the treatment of aspergillus brain abscess: case report and review of the literature.Aspergillus brain abscess is often a fatal disease, regardless of the mode of therapy. Most often seen in the compromised host, it is notoriously refractory to systemic antifungal agents and intrathecal antimycotics. Even with radical surgical debridement, only 13 patients, including the present case, have survived longer than 3 months after being treated for aspergillus brain abscess or granuloma. Studies have shown poor penetration of amphotericin b into the brain and cerebrospinal fluid. One way to achieve therapeutic levels of the agent near the abscess is through the direct introduction of the agent into the abscess site via an indwelling catheter. In the present case, a woman with an aspergillus abscess of the left temporal lobe was treated by a combination of systemic agents, radical debridement, and local therapy, resulting in a cure with a follow-up of 6 years. This is the first reported instance of the use of long-term, local antifungal therapy delivered to the area of the abscess cavity, using a closed reservoir system, and this patient is only the second renal transplant patient reported to have survived aspergillus brain abscess. This form of treatment produced no untoward long-term side effects or neurological sequelae. Local irrigation with antifungal agents should be considered in conjunction with systemic antifungal drugs and drainage and/or debridement in cases of fungal intracerebral aspergilloma. This technique may also prove useful with other fungal brain lesions.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/18. Transcatheter occlusion of a large pulmonary arteriovenous malformation.We report a patient with a large pulmonary arteriovenous malformation complicated by cerebral abscess. He was successfully treated by transcatheter embolization using bioptome-assisted delivery of multiple coils.- - - - - - - - - - ranking = 5keywords = catheter (Clic here for more details about this article) |
8/18. brain abscess as the first clinical manifestation of multiple pulmonary arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease).In this report we described a case of a cerebral abscess that developed in presence of asymptomatic pulmonary arteriovenous malformations (PAVMs) in a 53-year-old woman with hereditary hemorrhagic telangiectasia (HHT). The brain abscess was aspirated with good clinical result and the arteriovenous fistulae qualified for transcatheter embolotherapy. Each patient suspected to suffer from HHT should be diagnosed for the presence of visceral vascular malformations. Most of them are found in the lungs, liver and brain. early diagnosis and treatment of PAVM prevent the occurrence of severe neurological complications such as brain stroke or brain abscess. Cases of a cerebral abscess in adults of unexplained etiology should raise the suspicion of an asymptomatic PAVM.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
9/18. Cerebral aspergillosis due to aspergillus fumigatus in AIDS patient: first culture-proven case reported in brazil.Cerebral aspergillosis is a rare cause of brain expansive lesion in AIDS patients. We report the first culture-proven case of brain abscess due to aspergillus fumigatus in a Brazilian AIDS patient. The patient, a 26 year-old male with human immunodeficiency virus (hiv) infection and history of pulmonary tuberculosis and cerebral toxoplasmosis, had fever, cough, dyspnea, and two episodes of seizures. The brain computerized tomography (CT) showed a bi-parietal and parasagittal hypodense lesion with peripheral enhancement, and significant mass effect. There was started anti-toxoplasma treatment. Three weeks later, the patient presented mental confusion, and a new brain CT evidenced increase in the lesion. He underwent brain biopsy, draining 10 mL of purulent material. The direct mycological examination revealed septated and hyaline hyphae. There was started amphotericin b deoxycholate. The culture of the material demonstrated presence of the aspergillus fumigatus. The following two months, the patient was submitted to three surgeries, with insertion of drainage catheter and administration of amphotericin b intralesional. Three months after hospital admission, his neurological condition suffered discrete changes. However, he died due to intrahospital pneumonia. brain abscess caused by aspergillus fumigatus must be considered in the differential diagnosis of the brain expansive lesions in AIDS patients in brazil.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
10/18. aspergillosis of the CNS in a pediatric liver transplant recipient: case report and review.A 2-month-old infant who had undergone orthotopic liver transplantation at the age of 2 weeks for carbamoyl phosphate synthetase deficiency developed infection of the CNS due to aspergillus fumigatus. The patient was successfully treated with administration of a combination of antifungal agents (including intraventricular amphotericin b), drainage of the parietal lobe abscess, and cessation of immunosuppression. An intraventricular catheter was used both to obtain ventricular fluid for microbiologic testing and to deliver amphotericin b during nearly 4 months of treatment. We review literature on aspergillosis in solid-organ transplant recipients, especially those in whom the disease involves the CNS, and discuss in particular clinical presentation, diagnosis, treatment, and outcome.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
| | Next -> |