PREDISPOSING FACTORS, CLINICAL PRESENTATION AND OUTCOME OF REPEATED ASPIRATION IN CEREBRAL ABSCESS THROUGH A DRAINAGE TUBE IN SITU

Authors

  • Ahsan Aurangzeb
  • Shahbaz Ali Khan
  • Ehtisham Ahmed
  • Shakir Mehmood
  • Asghar Ali
  • Khalid Khan Zadran
  • Sajid Hussain

Abstract

Background: Cerebral abscess is a serious and life threatening complication of several diseases.Aspiration of the abscess cavity versus excision of capsule are still in debate for the capsulated, large,superficially located abscesses especially in patients with poor surgical fitness. The objective of thisstudy was to look for the clinical presentation and outcome of patients with repeated aspiration incerebral abscess through a drainage tube in situ. Methods: This prospective study was conducted inDepartment of Neurosurgery, Ayub Medical College, Abbottabad from Jan 2010 to Jun 2011. Twentythree patients with age ranges 6–21 years who had large, solitary, capsulated, superficially locatedabscesses, were included in this study. These patients had poor American Society of Anaesthesiologists(ASA) grading (grade III and IV). After thorough clinical examination and workup, patients weresubjected to operative procedure. The procedure included placement of 8 size nasogastric tube in theabscess cavity through a single burr hole. Under strict aseptic conditions, repeated aspiration of pus wasdone through the drain daily for 2–4 days consecutively at intervals of 24 hours. The demographic data,predisposing factors, clinical presentation, and outcome of patients with repeated aspiration throughdrain placed in abscess cavity were recorded. Postoperatively, gadolinium enhanced CT-scan was donetwice in the first month at the span of two weeks each, later on monthly for next 3 months. The CTscans were reviewed for recurrence or any other possible intracranial complications. Patients werefollowed for duration of 3 to 6 months. Results: The predisposing factors found were congenital heartdisease in 7 (30.4%) patients, spread of contagious infections like mastoiditis/Chronic suppurativeottitis media in 5 (21.7%) patients, sinusitis in 2 (8.6%) patients, meningitis in 5 (21.7%) patients,septicemia in 3 (13.7%) patients, and penetrating cranial injury in 1 (4.34%) patients. In 16 (69.5%)patients presenting complaints were headache and vomiting, altered sensorium in 8 (34.7%) patients,hemiparesis in 9 (39.1) patients, aphasia in 3 (13.1%) patients, papillodema in 2 (8.7%) patients, andseizures in 1 (4.34%) patients. The abscess resolved in 19(82%) of patients, recurrence occurred in 2(8.7%) of patients, and death occurred in 2 (8.7%). Conclusion: Cerebral abscess is a life threateningcondition requiring aggressive management measures. Aspiration of cerebral abscess with repeatedaspiration through a drainage tube is a life saving in patients with poor ASA grade with low recurrenceof abscess formation and low mortality.Keywords: Cerebral Abscess, brain abscess, aspiration of brain abscess.

References

Bernardini GL. Diagnosis and management of brain abscess and

subdural empyema. Curr Neurol Neurosci 2004;4:448–56.

Lutz TW, Landolt H, Wasner M, Gratzl O. Diagnosis and

management of abscesses in the basal ganglia and thalamus: a

survey. Acta Neurochir (Wein) 1994;127:91–8.

Osenbach RK, Loftus CM. Diagnosis and management of brain

abscess. Neurosurg Clin N Am 1992;3:403–20.

Mehnaz A, Syed AU, Saleem AS, Khalid CN. Clinical features

and outcome of cerebral abscess in congenital heart disease. J

Ayub Med Coll Abbottabad 2006;18(2):21–4.

Kao PT, Tseng HK, Liu CP, Su SC, Loe CM. Brain abscess:

clinical analysis of 53 cases. J Microbiol Immunol Infect

;36:129–36.

Moorthy RK, Rajshekhar V. Management of brain abscess: an

overview. Neurosurg Focus 2008;24(6):E3.

Sharma BS, Gupta SK, Khosia VK. Current concepts in the

management of pyogenic brain abscess. Neurol India

;48(2):105–11.

Mut M, Hazer B, Narin F, Akalan N, Ozgen T. Aspiration or

capsule excision? Analysis of treatment results for brain abscesses

at single institute. Turk Neurosurg 2009;19(1):36–41.

Kastenbauer S, Pfister HW, Wispelwey B. Scheld WM. Brain

abscess In: Scheld WM, Whitley RJ, Marra CM, (editors)

Infections of the central nervous system. (3rd ed). Philadelphia:

Lippincott Williams & Wilkins;2004.p. 479–507.

Bidzinski J, Koszewski W: The value of different methods of

treatment of brain abscess in the CT era. Acta Neurochir (Wien)

;105:117–20.

Joshi SM, Devkota UP: The management of brain abscess in a

developing country: are the results any different? Br J Neurosurg

;12:325–8.

Mampalam TJ, Rosenblum ML: Trends in the management of

bacterial brain abscesses: a review of 102 cases over 17 years.

Neurosurgery 1988;4:451–8.

Babu ML, Bhasin SK, Kanchan. Pyogenic brain abscess and its

management. JK Science 2002;4(1):21–3.

Yang SY, Zhao CS: Review of 140 patients with brain abscess.

Surg Neurol 1993;39:290–6.

Fischer EG. Mclennan JE, Suzuki Y. Cerebral abscess in children.

Am J Dis Child 1981;135:746–9.

Duma CM. Kondiziolka D. Lunsford LD. Image-guided

sterotactic treatment of non-AIDS related cerebral infection.

Sellrosurg Clin N Am 1992;3(2):291–302.

Brin RH. Brain abscess. In: Wilkins RH. Rengacharyy SS (Eds)

Neurosurgery. New York: Megraw-Hill;1985.p. 1928–56.

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Published

2011-12-01