1/6. Focal intracranial infections due to propionibacterium acnes: report of three cases.OBJECTIVE AND IMPORTANCE: Except for its role in shunt infections, propionibacterium acnes has been of little interest to neurosurgeons. The rarity and indolent nature of focal intracranial infections by P. acnes limit their recognition. Three cases of serious intracranial infection due to this organism are described. CLINCAL PRESENTATION: Three patients with histories of immunosuppression and neurosurgical procedures developed nonspecific, delayed presentations (5 wk to 5 yr after surgery) of intracranial infections. In two patients, radiological investigations showed enhancing lesions that were later found to be brain abscesses. A subdural empyema was found in the third patient. INTERVENTION: All three patients underwent surgical drainage of the purulent collections. P. acnes was isolated in each case, and each patient was treated with a 6-week course of intravenous penicillin. All three patients made good recoveries, and subsequent imaging showed no recurrence of the infectious collections. CONCLUSION: P. acnes is an indolent organism that may rarely cause severe intracranial infections. This organism should be suspected when an intracranial purulent collection is discovered in a patient with a history of neurosurgical procedures. Immunosuppressed patients may be susceptible to this otherwise benign organism. Surgical drainage and treatment with intravenous penicillin should be considered standard therapy.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
2/6. Propionibacterium infection associated with bovine pericardium dural allograft. Case report.Propionibacteria are known to play a part in postneurosurgical infections, primarily those involving ventricular shunts. Nevertheless, little is known about the association between dural allografts and propionibacterium infections. Two patients underwent craniotomy for supratentorial meningiomas and each received a dural allograft. Both patients subsequently presented with delayed epidural fluid collections several weeks after surgery. Propionibacterium species was cultured in samples from both patients. The allografts were removed and the patients were treated with appropriate antibiotic agents; one patient underwent an interval craniectomy. Both patients demonstrated neuroimaging and clinical improvement after surgery and antiobiotic therapy. These cases demonstrate the association of propionibacterium infections with dural allografts. Furthermore, in patients with latent and indolent infections, Propionibacterium spp. should be suspected and treated appropriately.- - - - - - - - - - ranking = 1.6keywords = bacterium (Clic here for more details about this article) |
3/6. lemierre syndrome complicated by cavernous sinus thrombosis, the development of subdural empyemas, and internal carotid artery narrowing without cerebral infarction. Case report.lemierre syndrome is an extremely rare complication of mild-to-moderate pharyngeal infections. The authors present an unusual case of lemierre syndrome in a 16-year-old boy with cavernous sinus thrombosis and right internal carotid artery narrowing without neurological sequelae, right subdural empyema, and cerebritis in the right temporal and occipital lobes. neuroimaging also demonstrated right jugular vein thrombosis. Cultures of samples from the blood proved positive for the presence of fusobacterium necrophorum. The patient underwent unilateral tonsillectomy, drainage of the peritonsillar abscess, and a myringotomy on the right side. Postoperatively the patient was treated conservatively with antibiotic therapy resulting in an excellent outcome.- - - - - - - - - - ranking = 0.2keywords = bacterium (Clic here for more details about this article) |
4/6. Fatal frontal sinusitis due to neisseria sicca and eubacterium lentum.Infectious sinusitis may on occasion be associated with meningitis, subdural empyema, epidural empyema, brain abscess, or osteomyelitis. We report a 29-year-old male patient with frontal sinusitis who developed all of these intracranial complications due to two previously unreported causative organisms, neisseria sicca and eubacterium lentum. The fulminant and fatal course resulting from locally invasive disease underscores the importance of early diagnosis and proper treatment of these complications. Possible exacerbating factors in this patient were sickle cell disease and immune compromise due to intravenous drug abuse.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
5/6. Postoperative subdural empyema caused by propionibacterium acnes--a report of two cases.Two patients with postoperative subdural empyema following burr hole evacuation of chronic subdural haematoma are reported, both caused by propionibacterium acnes. The need to consider this diagnosis in patients developing recurrent symptoms after surgical drainage of chronic subdural haematoma is emphasized.- - - - - - - - - - ranking = 1keywords = bacterium (Clic here for more details about this article) |
6/6. Intracranial tuberculous subdural empyema: case report.OBJECTIVE AND IMPORTANCE: Many types of neurotuberculosis have been described; the most common intracranial forms are tuberculous meningitis and tuberculomas. We report a unique and as yet unreported form of neurotuberculosis, which is an intracranial tuberculous subdural empyema. CLINICAL PRESENTATION: A 59-year-old man who had been previously treated for pulmonary tuberculosis (TB) presented at our institution with a long-standing history of headaches. General and neurological examinations revealed no abnormalities. radiography of the chest confirmed fibrotic lung changes caused by healed pulmonary TB. A cranial computed tomographic scan revealed a hypodense extra-axial collection with mass effect as well as adjacent osteitis and scalp swelling. INTERVENTION: The patient underwent craniectomy of the osteitic bone and drainage of 50 ml of fluid pus located subdurally. Microscopic examination of the bone and pus revealed tuberculous granulation tissue with numerous acid-fast bacilli identified using Ziehl-Neelsen stain. mycobacterium TB bacillus was cultured from the pus at 42 days. The patient required two further operative procedures as well as a protracted course of anti-TB therapy. CONCLUSION: The patient eventually achieved a good recovery. We recommend surgical drainage of tuberculous subdural empyema to relieve mass effect and to obtain microbiological confirmation. Furthermore, surgical treatment should be combined with an 18-month course of anti-TB chemotherapy, during which period patient compliance should be closely monitored.- - - - - - - - - - ranking = 0.2keywords = bacterium (Clic here for more details about this article) |