[Non-invasive management of multiple brain abscesses. Case report and review of the literature].
The authors report a case and treatment of multiple brain abscesses located in the cerebrum and cerebellum combined with subdural empyema. In conjunction with the case report, the authors review the literature on the pathogenesis of brain abscesses and discuss therapeutic strategies concerning the topic. In the case presented, the primary infection persisted in the lung causing subclinical bronchitis. The hemoculture showed evidence of Streptococcus mitis infection. Although the etiological role of this bacterium in meningitis is known, it rarely causes bacterial meningitis without underlying predisposing factors. In their case, the patient was free of the most common predisposing factors such as congenital heart disease or immunodeficiency. Following the 2 month period of latency, a rapid onset of the symptoms of intracranial inflammation could be observed: fever, headache, meningeal symptoms, focal neurological symptoms and coma. They were not able to identify any bacteria in the cerebrospinal fluid; the Streptocossus mitis could be cultivated only from the haemoculture. The cytological analysis of the cerebrospinal fluid showed typical signs of bacterial infection and the cranial Computed Tomography revealed multiple cerebral abscesses. Neurosurgical intervention was not recommended because of the number, localization and size of the focal lesions. The therapy consisted of intravenous administration of 24 x 10(6) IU/die Penicillin and 4 g/die ceftriaxon. For supportive therapy, Mannitol B, 3 mg/die clonazepam and 300 mg/die phenytoin were administered. Corticosteroids were not used during the course of therapy. Two years later the 55 year old female is symptom free and doing well.
Hoffmann
I
I
Neurológiai osztály, Magyar Honvédség Pécsi Kórháza.
Késmárki
I
I
Kincses
J
J
Ekler
K
K
D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008169:Lung Abscess / Q000150:complications / Q000382:microbiology*; D008875:Middle Aged; D013290:Streptococcal Infections / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome