1/31. Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: case report.OBJECTIVE AND IMPORTANCE: Infratentorial empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis are all rare and potentially lethal conditions. The occurrence of all three in a single patient has not previously been described. We present such a case occurring in a young, otherwise healthy man. CLINICAL PRESENTATION: A 26-year-old man with a remote history of sinusitis developed rapidly progressive headache, fever, right eye pain, swelling, proptosis, and visual impairment. magnetic resonance imaging demonstrated diffuse pansinusitis, including sphenoid sinusitis, and extension of inflammation and infection into the adjacent cavernous sinuses, pituitary gland, and posterior fossa. INTERVENTION: Urgent drainage of the ethmoid and maxillary sinuses was performed; pus was not identified. The patient continued to deteriorate clinically with worsening of visual acuity. Computed tomography of the head performed the next day revealed worsening hydrocephalus and an enlarging posterior fossa subdural empyema. Urgent ventricular drainage and evacuation of the empyema was performed, and subsequently, the patient's clinical course improved. The microbiology results revealed alpha hemolytic streptococcus and coagulase-negative staphylococcus species. The patient survived but during the follow-up period had a blind right eye and pituitary insufficiency. CONCLUSION: Paranasal sinusitis can have devastating intracranial sequelae. Involvement of the adjacent pituitary gland and cavernous sinuses can result in serious neurological morbidity or mortality, and retrograde spread of infection through the basal venous system can result in subdural or parenchymal brain involvement. A high index of suspicion and aggressive medical and surgical treatment are crucial for patient survival, but the morbidity rate remains high. Our patient survived but lost anterior pituitary function and vision in his right eye.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/31. Non-typhoid Salmonella subdural empyema in children: report of two cases.Subdural empyema caused by Salmonella in childhood is an uncommon condition. The predisposing factors for this condition are not clearly established, especially in young children. Here we present two cases of subdural empyema caused by non-typhoidal Salmonella. Both of the patients suffered prolonged fever without local signs of infection on admission. Subdural empyema was subsequently detected by brain echo and brain computerized tomography (CT) scan in both cases. cerebrospinal fluid (CSF) study was not done in case one due to prominent mass effect on brain CT; in case two the CSF analysis showed pleocytosis, but CSF bacterial culture was negative. Neither enteritis nor obvious meningeal sign was noted. Both cases responded well to surgical drainage and systemic antibiotics treatment.- - - - - - - - - - ranking = 3keywords = brain (Clic here for more details about this article) |
3/31. Extensive subdural empyema treated with drainage and barbiturate therapy under intracranial pressure monitoring: case report.In subdural empyema (SDE), if the mass effect and vasogenic edema are not controlled, the brain can be fatally damaged. Massive SDE over the skull base often requires repeated surgical drainage for removal of accumulated pus. intracranial pressure (ICP) management until obliteration of the empyema is important to the improvement of clinical outcome. An 18-year-old man was admitted to our center in a nearly comatose state and with a mild fever. CT scan showed massive SDE extending to the skull base and parafalx. ICP was measured with a pressure transducer through an intraventricle tube. Repeated surgical drainage was performed while ICP was controlled with barbiturate therapy. He was discharged with no neurological deficits. In patients with an extensive SDE over the cerebral hemisphere, ICP control with barbiturate therapy may enhance the therapeutic effect of surgical drainage.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
4/31. 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 = brain (Clic here for more details about this article) |
5/31. 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 = 1keywords = brain (Clic here for more details about this article) |
6/31. Intracranial salmonella infections: meningitis, subdural collections and brain abscess. A series of six surgically managed cases with follow-up results.Focal intracranial infections due to Salmonella are rare. So far, around 80 cases have been reported in the world literature. The authors present their experience of 6 cases of intracranial salmonella infections, mainly subdural empyema in 5 and effusion in 1. In 1 case, subdural empyema was bilateral, and in another case, there was an associated brain abscess. Positive blood cultures and positive Widal tests were noticed in 2 patients each. early diagnosis and prompt evacuation of subdural collections and brain abscess and antibiotic therapy lead to satisfactory results. This study suggests that a high index of suspicion, early diagnosis and quick evacuation lead to success; this point is highlighted with the help of a review of the literature.- - - - - - - - - - ranking = 6keywords = brain (Clic here for more details about this article) |
7/31. empyema of the cavum septum pellucidum.The cavum septum pellucidum is not a part of the brain's ventricular system and does not communicate with the lateral ventricles. However, under conditions of increased intraventricular pressure, cerebrospinal fluid may penetrate the septum and cause formation of a cavity. We report a neonate with pus accumulation in the cavum septum pellucidum after an episode of ventriculitis. The cavum septum pellucidum disappeared after medical and surgical management of the infection and increased intracranial pressure.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
8/31. Bifrontal decompressive craniectomy for acute subdural empyema.INTRODUCTION: Subdural empyema is an uncommon but serious complication of sinusitis. Despite the use of advanced imaging facilities, modern antibiotic therapy and aggressive neurosurgical protocols, this condition still carries significant morbidity and mortality. CASE REPORT: We report an unusual case of sinusitis-associated acute subdural empyema in a 13-year-old patient, presenting in a catastrophic manner with acutely raised intracranial pressure. Emergency bifrontal decompressive craniectomy was necessary both to reduce the intracranial pressure and to drain the subdural empyema. RESULTS: The full range of intracranial complications subsequently occurred, including brain abscesses, recurrent subdural empyema and ventriculitis. Despite this, the patient's outcome was good, with minimal intellectual deficits. CONCLUSION: In cases of severe intracranial infection, we therefore advocate an aggressive surgical approach coupled with appropriate antibiotics to ensure a good outcome.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
9/31. Supra- and infratentorial subdural empyema secondary to septicemia in a patient with liver abscess--case report.An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
10/31. Group A streptococcal subdural empyema as a complication of varicella.Group A beta-hemolytic streptococcus and staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from british columbia, canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and streptococcus pyogenes was recovered from the subdural fluid. central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.- - - - - - - - - - ranking = 0.39172183278061keywords = nervous system (Clic here for more details about this article) |
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