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PROFILE OF BRAIN ABSCESSES IN PEDIATRIC POPULATION AT AIIMS Agrawal D., Mahapatra A.K., Suri A. Department Of Neurosurgery, All India Institute Of medical Sciences, New Delhi-29
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PROFILE OF BRAIN ABSCESSES EPIDEMIOLOGY EPIDEMIOLOGY TOTAL OF 89 PTS. (JAN.99 - SEP.01) 67 PEDIATRIC 11 (16%) FEMALE 56 (84%) MALE
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PROFILE OF BRAIN ABSCESSES PRESENTING SIGNS PRESENTING SIGNS ALTERED SENSORIUM – 19 (28%) CRANIAL NERVE PALSIES VII – 9 (13%) VI – 5 (7.5%) HEMIPARESIS – 14 (21%) NO DEFICITS – 20 (30%)
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PROFILE OF BRAIN ABSCESSES LOCATION LOCATION SUPRATENTORIAL – 52 (78%) INFRATENTORIAL – 15 (22%)
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PROFILE OF BRAIN ABSCESSES ETIOLOGY ETIOLOGY CYANOTIC HEART DISEASE – 21 (31%) CSOM – 14 (21%) TUBERCULAR – 11 (16%) INFECTED DERMOID – 5 (7.5%) NEONATAL MENINGITIS – 8 (12%) UNKNOWN – 8 (12%)
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PROFILE OF BRAIN ABSCESSES CAUSATIVE ORGANISM CAUSATIVE ORGANISM MSSA – 9 (13%) STREP. VIRIDANS – 3 (4.5%) CITROBACTER – 2 (3%) MRSA – 1 (1.5%) ACID FAST BACILLI – 1 (1.5%) FALCIPARUM MALARIA – 1 (1.5%) NO ORGANISM ISOLATED – 51 (76%)
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PROFILE OF BRAIN ABSCESSES MANAGEMENT MANAGEMENT A TOTAL OF 85 BURR HOLE ASPIRATIONS AND 29 ABSCESS EXCISIONS WERE DONE IN 67 PATIENTS
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PROFILE OF BRAIN ABSCESSES MANAGEMENT (contd.) MANAGEMENT (contd.) 23 (34%) PATIENTS – 2 OR MORE ASPIRATIONS 10 (15%) PATIENTS – PRIMARY EXCISION 19 (28%) PATIENTS – EXCISION FOLLOWING ASPIRATION
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PROFILE OF BRAIN ABSCESSES MANAGEMENT (CONTD.) MANAGEMENT (CONTD.) PRIMARY MODALITY OF TREATMENT INFRATENTORIAL ABSCESSES– EXCISION SUPRATENTORIAL ABSCESSES - BURR HOLE ASPIRATION
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PROFILE OF BRAIN ABSCESSES PRE TAPPINGPOST TAPPING BASAL GANGLIA ABSCESS
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PROFILE OF BRAIN ABSCESSES POSTERIOR FOSSA ABSCESSSUB DURA EMPYMA
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PROFILE OF BRAIN ABSCESSES HOSPITAL STAY HOSPITAL STAY AVERAGE HOSPITAL STAY – 12 DAYS MINIMUM STAY – 4 DAYS MAXIMUIM STAY – 32 DAYS
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PROFILE OF BRAIN ABSCESSES FOLLOW UP FOLLOW UP AVAILABLE FOR 51 (76%) PATIENTS AVERAGE FOLLOW UP 5.6 MONTHS (RANGE 1 MONTH – 24 MONTHS)
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PROFILE OF BRAIN ABSCESSES SEQUELAE SEQUELAE 14 (21%) - HYDROCEPHALUS 14 (21%) - HYDROCEPHALUS 4 PATIENTS REQUIRED SHUNT PLACEMENT 7 (10%) – SEIZURES 7 (10%) – SEIZURES 2 (3%) – DIED 2 (3%) – DIED (BOTH HAD SUBDURAL EMPYMA)
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PROFILE OF BRAIN ABSCESSES SEQUELAE
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PROFILE OF BRAIN ABSCESSES CONCLUSIONS CONCLUSIONS - We prefer primary excision of abscess in Infratentorial compartment and Aspiration in other regions. - Tuberculosis should be strongly suspected in all cases and searched for.
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- Hydrocephalus can develop in a number of successfully treated patients(21%in our series), though only a small percentage will require shunt placement. PROFILE OF BRAIN ABSCESSES CONCLUSIONS (Contd.) CONCLUSIONS (Contd.)
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