An 11-Year-Old Girl With Right-Sided Weakness Secondary to Cerebral Abscesses A Case Report
ABSTRACT A previously healthy 11-year-old girl who presented to the emergency department with 8 days of headache and right-sided weakness was found to have 2 cerebral abscesses. Brain abscess is an uncommon finding for children in the emergency department. With this case, we review the clinical presentation, evaluation, and management of this unusual but potentially life-threatening condition.
- Brain 07/1973; 96(2):259-68. DOI:10.1093/brain/96.2.259 · 10.23 Impact Factor
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ABSTRACT: Brain abscesses represent the most common form of intracranial suppuration in children.1-3 These ab-scesses can arise as the result of direct spread from contiguous anatomical structures,4,5 from metastatic spread from a distant focus,6 as a result of penetrating injury of the cranium or compound fracture of the skull or postoperatively. Brain abscess also can develop as a complication of congenital cyanotic heart disease.7 Typically brain abscesses arising from para-meningeal foci are single and are located in the temporal or frontal lobes,4,5 while those arising from distant foci are multiple and occur widely throughout the brain substance.6 By whatever means the microorganisms reach the brain, their presence is characterized by a focus of ischemia with resultant necrotic brain tissue providing a microaerophilic environment suitable for bacterial poliferation.8 The organisms isolated from brain abscesses have included aerobes and both facultative and obligate anaerobes.9-11.Pediatric infectious disease 01/1985; 4(4):394-8. DOI:10.1097/00006454-198507000-00013
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ABSTRACT: The neuropathological progression of brain abscess formation was studied experimentally at sequential stages in dogs, and the findings correlated with the appearance on computerized tomographic (CT) brain scans. The evolution of brain-abscess formation was divided into four stages based on histological criteria: early cerebritis (Days 1 to 3); late cerebritis (Days 4 to 9); early capsule (Days 10 to 13); and late capsule (Days 14 and later). The cerebritis stage was characterized by prominent perivascular cuffing by inflammatory cells in the area adjacent to the developing necrotic center. However, the early elements of capsule formation appeared with the presence of fibroblasts by Day 5. The CT scans showed ring-shaped contrast enhancement by Day 3. Delayed scans at 30 minutes revealed diffusion of the contrast material into the developing necrotic center, forming a solid lesion. In lesions that were well encapsulated (14 days and older), five distinct histological zones were apparent: 1) a well formed necrotic center; 2) a peripheral zone of inflammatory cells, macrophages, and fibroblasts; 3) the dense collagenous capsule; 4) a layer of neovascularity associated with continuing cerebritis; and 5) reactive astrocytes, gliosis, and cerebral edema external to the capsule. The CT appearance of well encapsulated abscesses showed a typical ring-shaped contrast-enhancing lesion. On the delayed scans, the "ring" did not fill in with contrast enhancement. The diameter of the ring correlated best with the presence of cerebritis (perivascular infiltrates in the adventitial sheaths of vessels surrounding the abscess). The discussion focuses on the relevance of this study to the current management of patients with brain abscess.Journal of Neurosurgery 11/1981; 55(4):590-603. DOI:10.3171/jns.1981.55.4.0590 · 3.23 Impact Factor