Clinical Characteristics and Outcome Assessment of Brain Abscess in Children and Adolescents; a 2 Years Neurosurgical Perspective

Authors

  • Muhammad Ali Nouman Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan
  • Muhammad Mukhtar Khan Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan
  • Atif Aman Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan
  • Ayaz Ahmed Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan
  • Muhammad Nasir Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan
  • Muhammad Tariq Department of Neurosurgery, Hayatabad Medical Complex, Peshawar – Pakistan

Keywords:

Paediatrics, Central Nervous System, Infection, Brain Abscess, Bacterial

Abstract

Background: Brain abscess is a serious infective disorder of the central nervous system with high rates of prolonged morbidity and mortality. Effective neurosurgical management is the key to lower morbidity and death rates due to this disease.
Material and Methods: This study was conducted prospectively at the Department of Neurosurgery, Hayatabad Medical Complex Peshawar from January 2013 to December 2014. Presenting clinical features, radiological characteristics and surgical findings were recorded. Emphasis was placed to test the effectiveness of prompt surgery, good antibiotic coverage and the use of drainage tubes in reducing recurrence rates and lowering mor-bidity and mortality. The patients were followed for one month postoperatively and their functional outcome plus radiological resolution recorded.
Results: 48 cases were included in the study with 33 (68.8%) males and 15 (31.3%) females and mean age of 9.7 years (SD ± 4.5). Median GCS on presentation was 12 (SD ± 3.1) and mean diameter of the abscess cavity was 4.8 cm (SD ± 1.3). The mean of length of stay was 6.6 days (SD ± 2.7) while median GOS at discharge was found to be 4 (SD ± 1.2). Eighteen of the 48 patients were lost to follow up. Overall mortality was 14.6% (7 patients). There was a significant correlation between admission GCS and GOS at discharge (r = 0.87 and p = < 0.001).
Conclusion: The paediatric age group is more susceptible to central nervous system infections and cerebral abscess development. Moreover, the higher prevalence of congenital heart diseases, pulmonary disorders and head trauma leads to higher incidence, prolonged morbidity and increased mortality. Surgical interventions for brain abscess have good outcome. However, early diagnosis is the key to saving lives.

References

1. Tunkel AR, Sceld WM. Brain Abscess. In: Winn HR, editor. Youmans neurological surgery. 6th ed. Philadel-phia: Elsevier; 2011.
2. Zhang C, Hu L, Wu X, Hu G, Ding X, Lu Y. A retro-spective study on the aetiology, management, and out-come of brain abscess in an 11 – year, single – centre study from China. BMC Infect Dis. 2014; 14: 311.
3. Hussain A, Khan AR. Frequency of intracranial compli-cations in chronic otitis media. J Ayub Med Coll Abbo-ttabad, 2005 Jan – Mar; 17 (1): 75-7.
4. Mehnaz A, Syed AU, Saleem AS, Khalid CN. Clinical features and outcome of cerebral abscess in congenital heart disease. J Ayub Med Coll Abbottabad, 2006; 18 (2): 21-4.
5. Khan A, Khan MI, Muhammad. Intracranial complica-tions of chronic suppurative otitis media: clinical pre-sentation and outcome of surgical procedures. Gomal J Med Sci. 2012; 10: 186-9.
6. Bakshi R, Wright PD, Kinkel PR, et al. Cranial magne-tic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients. J Neuroimaging, 1999; 9: 78.
7. Qureshi HU, Siddiqui A, Habib AA, Mozaffar T, Sar-wari AR. Predictors of mortality in brain abscess. JP-MA, 2002; 111: 52.
8. Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of cerebritis, encephalitis, and brain abscess. Neuroimag-ing Clin N Am. 2012 Nov; 22 (4): 585-607.
9. Simpson D. Management of brain abscesses. I: Drain-age and antiseptics. J Clin Neurosci. 2013 Dec; 20 (12): 1669-74.
10. Simpson D. Management of brain abscesses. II: Anti-biotics and computed tomography. J Clin Neurosci. 2013 Dec; 20 (12): 1675-81.
11. Lu CH, Chang WN, Lin YC, Tsai NW, Liliang PC, Su TM, et al. Bacterial brain abscess: microbiological fea-tures, epidemiological trends and therapeutic outcomes. Q J Med. 2002; 95: 501-9.
12. Atiq M, Ahmed US, Allana SS, Chishti KN. Brain abs-cess in children. Indian J Pediatr. 2006; 73 (5): 401-4.
13. Alvis Miranda H, Castellar – Leones SM, Elzain MA, Moscote – Salazar LR. Brain abscess: Current manage-ment. J Neurosci Rural Pract. 2013 Aug; 4 (Suppl. 1): S67-81.
14. Shachor – Meyouhas Y, Bar – Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I.Brain abscess in children-epidemiology, predisposing factors and management in
the modern medicine era. Acta Paediatr. 2010 Aug; 99 (8): 1163-7.
15. Auvichayapat N, Auvichayapat P, Aungwarawong S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007 Aug; 90 (8): 1601-7.
16. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hos-pital Boston. Pediatrics, 2004 Jun; 113 (6): 1765-70.
17. Radoi M, Ciubotaru V, Tataranu L. Brain abscesses: Clinical experience and outcome of 52 consecutive cas-es. Chirurgia. 2013; 108 (2): 215-25.
18. Hsiao SY, Chang WN, Lin WC, Tsai NW, Huang CR, Wang HC, et al. The experiences of non-operative treat-ment in patients with bacterial brain abscess. Clin Mic-robiol Infect. 2011; 17 (4): 615-20.
19. Mace SE. Central nervous system infections as a cause of an altered mental status? What is the pathogen grow-ing in your central nervous system? Emerg Med Clin North Am. 2010; 28 (3): 535-70.
20. Sarmast AH, Showkat HI, Kirmani AR, Bhat AR, Patloo AM, Ahmad SR, et al. Aspiration vs. excision: A single center experience of forty – seven patients with brain abscess over 10 years. Neurol Med Chir (Tokyo), 2012; 52: 724-30.
21. Aurangzeb A, Khan SA, Ahmed E, Mehmood S, Ali A, Zadran KK, et al. Predisposing factors, clinical presen-tation and outcome of repeated aspiration in cerebral abscess through a drainage tube in situ. J Ayub Med Coll Abbottabad, 2011; 23 (4): 58-60.
22. Ratnaike TE, Das S, Gregson BA, Mendelow AD. A re-view of brain abscess surgical treatment – 78 years: as-piration versus excision. World Neurosurg. 2011 Nov; 76 (5): 431-6.
23. Nathoo N, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg. 2011 May – Jun; 75 (5-6): 716-26; discussion 612-7.

Downloads

Published

2015-03-30

Issue

Section

Original Articles