Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management.
Nocardia asteroides cerebral abscesses are rare but challenging intracranial lesions. Early diagnosis, institution of appropriate antimicrobial therapy, lack of underlying systemic disease and limited intracranial disease are recognized factors leading to good outcome. However, the optimal treatment approach has not been established and nocardial brain abscesses have been managed either conservatively, with steroetactic aspirations or with open craniotomy and enucleation. We present three cases of Nocardia asteroides cerebral abscesses cured only after neurosurgical enucleation, and discuss the current management alternatives and conclude that a more aggressive approach than that currently preferred for this entity may be more effective.
Valarezo
Javier
J
Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel. valarezoxavier@hotmail.com
Cohen
José E
JE
Valarezo
Luis
L
Spektor
Sergey
S
Shoshan
Yigal
Y
Rosenthal
Guy
G
Umansky
Felix
F
D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D001932:Brain Neoplasms / Q000473:pathology; D002439:Cefotaxime / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D009617:Nocardia Infections / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009616:Nocardia asteroides / Q000302:isolation & purification*; D013411:Sulfadiazine / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D013411:Sulfadiazine; D015378:Imipenem; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000583:Amikacin; D002439:Cefotaxime