title: [Successful treatment of brain stem and thalamic abscesses with high-dose meropenem].
abstract: The incidence of brain abscess remains high, despite the development of novel antibiotics. Vancomycin or carbapenems, which are third-generation cephems, are recommended as standard therapy for bacterial meningitis or brain abscess. The effectiveness of the high-dose meropenem therapy on brain abscess has occasionally been reported. We experienced 2 consecutive cases of brain abscess in adults. The first patient was a 67-year-old man with diplopia, dizziness, and dysesthesia on the left upper and lower extremities. Images of T1-weighted magnetic resonance imaging (MRI) with contrast medium and diffusion-weighted MRI showed a ring enhancing cystic lesion and a high intensity lesion, respectively, in the right pons. The second patient was a 37-year-old man who complained of right hemiparesis. MRI revealed a ring-enhancing cystic mass in the left thalamus. On the basis of MRI findings, patients were diagnosed with brain abscess and were given high-dose meropenem (6g/day) continuously for 2 months. The abscess resolved completely after treatment with meropenem administered intravenously. Further, neurological deficits caused by abscess successfully improved. High-dose meropenem therapy should be considered as an effective treatment for brain abscess, even in the brain stem and basal ganglia, where it is quite difficult to achieve surgical access.
authors.affiliation: Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Chiba, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sakamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Kato
authors.forename: Takao
authors.initials: T
authors.lastname: Arai
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001922:Brain Abscess / Q000175:diagnosis / Q000188:drug therapy*; D001933:Brain Stem; D006801:Humans; D008297:Male; D000077731:Meropenem; D013786:Thalamic Diseases / Q000188:drug therapy*; D013845:Thienamycins / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem