title: Diagnostic and management of pediatric brain stem abscess, a case-based update.
abstract: OBJECTIVE
  Authors report their experience of a pediatric brain stem abscess with a literature review.
  
  
  METHODS
  A 2.5-year-old girl first displayed bacterial otitis 3 months before admission. Diagnosis of brain stem abscess was delayed, despite plethoric neurological signs. She complained of right hemiparesis, headache, squint, dysphagia, and false way inhalation pneumopathy. Brain magnetic resonance imaging revealed presence of an abscess in the pons, prompting for a microsurgical pus aspiration. Postoperative course was regular with a total neurological recovery. Clinical and radiological screening showed progressive regression of the pontine lesion after 4 months, despite persistence of a mild contrast enhancement. Present case is the 18th pediatric brain stem abscess reported in literature.
  
  
  RESULTS
  Mean age of occurrence is 8.1 ± 4 years (range 0.75-16) without gender predominance. High morbidity is typical and essentially involves motor functions. The most common clinical signs are raised intracranial pressure, motor limbs deficit, and cranial nerve palsies. Fever was found in 10 out of 18 cases (56%). Three patients received conservative medical treatment. Three patients underwent stereotactic aspiration and 12 others underwent microsurgical aspiration or excision. No mortality was reported since the eighties. However, morbidity is still high.
  
  
  CONCLUSIONS
  High clinical index of suspicion is necessary to improve functional outcome. Stereotactic-guided or microsurgical aspiration are still good therapeutic options. The rarity of pediatric brain stem abscesses and the need of optimal management make this case-based update very peculiar.
authors.affiliation: Department of Neurosurgery, UHC Mohammed VI, Faculty of Medicine, Cadi Ayyad University, Marrakesh, Morocco.
authors.forename: Houssine
authors.initials: H
authors.lastname: Ghannane
authors.forename: Mehdi
authors.initials: M
authors.lastname: Laghmari
authors.forename: Khalid
authors.initials: K
authors.lastname: Aniba
authors.forename: Mohammed
authors.initials: M
authors.lastname: Lmejjati
authors.forename: Saïd Ait
authors.initials: SA
authors.lastname: Benali
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D006801:Humans; D010035:Otitis Media, Suppurative / Q000150:complications; D011149:Pons / Q000473:pathology* / Q000601:surgery; D013238:Stereotaxic Techniques; D013396:Suction
chemical_list: D000900:Anti-Bacterial Agents