Intracerebral Abscess Associated With the Camino Intracranial Pressure Monitor: Case Report and Review of the Literature
ABSTRACT Intracranial pressure (ICP) monitoring is a mainstay in the management of traumatic brain injury. Large investigations have validated the safety and efficacy of ICP monitors in comatose patients. Clinically relevant infections are extremely rare and cerebral abscess has never been reported with the Camino device. We describe an exceptional case of a life-threatening intracerebral abscess from an intraparenchymal ICP monitor.
A 35-month-old child required 7 days of ICP monitoring after a fall from a 2-story window. His hospital course was complicated by severe airway edema treated, in part, with high-dose corticosteroid therapy for a total of 10 days. Two weeks later, the patient deteriorated acutely owing to a large intracerebral abscess under the previous ICP monitor site. Urgent craniotomy with evacuation of the abscess was performed on 2 separate occasions. Cultures grew methicillin-sensitive Staphylococcus aureus, which was treated with long-term antibiotics. At the 3-month follow-up, the patient was meeting age-appropriate milestones without focal deficits.
To the best of our knowledge, this is the first report describing an intracerebral abscess as a complication from an intraparenchymal pressure monitor. Corticosteroid therapy may have constituted an independent risk factor for the ICP monitor--associated infection, as well as reinsertion of the ICP monitoring device at the same site. That this is the first reported parenchymal infectious complication underscores the safety of this device with respect to infection. When reinsertion of a parenchymal monitor is considered, a new site should be chosen.
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ABSTRACT: Intracranial-pressure (ICP) monitoring is useful for patients with increased ICP following hemorrhagic stroke. In this study, the changes in pressure gradients between the two cerebral hemispheres were investigated after hemorrhagic stroke of one side, and after a craniotomy. Twenty-four patients with acute cerebral hemorrhages and intracerebral hematomas who exhibited mass effect and midline shift to the contralateral side on computed tomography were selected for this study. After admission, both sides of the cranium were drilled, and optical fiber sensors were implanted to monitor the brain parenchyma pressure (BPP) in both cerebral hemispheres. All patients underwent surgical hematoma evacuations. The preoperative and postoperative BPP data from both cerebral hemispheres were collected at various time points and compared pairwise. There were statistically significant differences (P < 0.01) in the preoperative BPP values between the two hemispheres at three different time points. Differences in the BPP values between the two hemispheres at the time of surgery, and 24 and 48 h after surgery, were not statistically significant (P > 0.05). The posteroperative BPPs of both hemispheres were statistically significantly lower than preoperative recordings. BPP sensors should be applied to the injured cerebral hemisphere, because this becomes the source of increased ICP. Hematoma evacuation surgery effectively decreases ICP and eliminates pressure gradients between the two cerebral hemispheres, consequently enabling brain shift correction.BMC Anesthesiology 12/2014; 14:112. DOI:10.1186/1471-2253-14-112 · 1.33 Impact Factor
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ABSTRACT: Bacterial CNS infections comprise a wide spectrum of diseases, which may be acquired outside or inside the hospital, affect immunocompetent or immunocompromised patients, and be associated with trauma or procedures, as well as other exposures.Current Infectious Disease Reports 11/2013; 15(6). DOI:10.1007/s11908-013-0384-7
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ABSTRACT: Advantages of telemetric devices for long-term intracranial pressure (ICP) measurement have been mentioned several times in the literature. However, descriptions of associated complications are lacking. Therefore, the presented observational study focused on clinical and radiological findings after insertion of an intraparenchymal telemetric ICP monitor. Between April 2010 and February 2013, 185 telemetric ICP catheters were implanted for diagnostic purposes. All patients were clinically followed. Radiological, microbiological and clinical data were analysed. One brain abscess (0.5 %) and two cutaneous infections (1.1 %) occurred in 185 patients. Staphylococcus spp. could be detected in all cases. Six patients (3.2 %) suffered from single new-onset seizures and one patient (0.5 %) from a temporary hemiparesis. Intracerebral haemorrhages occurred in 15.6 %, most of the time as small punctate bleedings. Perifocal oedematous reactions surrounding inserted telemetric catheters could be observed in 46.9 %. Multiple imaging studies revealed a tendency of complete oedema resolution over time. Infectious as well as haemorrhagic complication rates are well comparable with the common literature. The long-term implantation of an ICP probe does not seem to increase the risk of wound infections or brain abscess formation. Surprisingly, very high numbers of oedematous reactions after insertion of the intraparenchymal ICP monitor were seen. Reasons therefore could only be speculated upon.Acta Neurochirurgica 02/2014; 156(5). DOI:10.1007/s00701-013-1991-7 · 1.79 Impact Factor