profile of brain abscesses in pediatric population at aiims agrawal d., mahapatra a.k., suri a....

PROFILE OF BRAIN PROFILE OF BRAIN ABSCESSES IN PEDIATRIC ABSCESSES IN PEDIATRIC

POPULATION AT AIIMS POPULATION AT AIIMS

Agrawal D., Mahapatra A.K., Suri Agrawal D., Mahapatra A.K., Suri A.A.

Department Of Neurosurgery, All Department Of Neurosurgery, All India Institute Of medical India Institute Of medical Sciences, New Delhi-29Sciences, New Delhi-29

PROFILE OF BRAIN PROFILE OF BRAIN ABSCESSESABSCESSES

EPIDEMIOLOGYEPIDEMIOLOGY

TOTAL OF 89 PTS. (JAN.99 - SEP.01) TOTAL OF 89 PTS. (JAN.99 - SEP.01)

67 PEDIATRIC67 PEDIATRIC

11 (16%) FEMALE 11 (16%) FEMALE

56 (84%) MALE56 (84%) MALE


PRESENTING SIGNSPRESENTING SIGNS

ALTERED SENSORIUM – 19 (28%)ALTERED SENSORIUM – 19 (28%)CRANIAL NERVE PALSIES CRANIAL NERVE PALSIES

VII – 9 (13%)VII – 9 (13%)

VI – 5 (7.5%)VI – 5 (7.5%)

HEMIPARESIS – 14 (21%)HEMIPARESIS – 14 (21%)

NO DEFICITS – 20 (30%)NO DEFICITS – 20 (30%)


LOCATIONLOCATION

SUPRATENTORIAL – 52 (78%)SUPRATENTORIAL – 52 (78%)

INFRATENTORIAL – 15 (22%)INFRATENTORIAL – 15 (22%)


ETIOLOGYETIOLOGY

CYANOTIC HEART DISEASE – 21 (31%)CYANOTIC HEART DISEASE – 21 (31%)

CSOM – 14 (21%)CSOM – 14 (21%)

TUBERCULAR – 11 (16%)TUBERCULAR – 11 (16%)

INFECTED DERMOID – 5 (7.5%)INFECTED DERMOID – 5 (7.5%)

NEONATAL MENINGITIS – 8 (12%)NEONATAL MENINGITIS – 8 (12%)

UNKNOWN – 8 (12%)UNKNOWN – 8 (12%)


CAUSATIVE ORGANISMCAUSATIVE ORGANISM

MSSA – 9 (13%)MSSA – 9 (13%)

STREP. VIRIDANS – 3 (4.5%)STREP. VIRIDANS – 3 (4.5%)

CITROBACTER – 2 (3%)CITROBACTER – 2 (3%)

MRSA – 1 (1.5%)MRSA – 1 (1.5%)

ACID FAST BACILLI – 1 (1.5%)ACID FAST BACILLI – 1 (1.5%)

FALCIPARUM MALARIA – 1 (1.5%)FALCIPARUM MALARIA – 1 (1.5%)

NO ORGANISM ISOLATED – 51 (76%)NO ORGANISM ISOLATED – 51 (76%)


MANAGEMENT MANAGEMENT

A TOTAL OFA TOTAL OF

85 BURR HOLE ASPIRATIONS AND85 BURR HOLE ASPIRATIONS AND

29 ABSCESS EXCISIONS WERE DONE 29 ABSCESS EXCISIONS WERE DONE IN 67 PATIENTSIN 67 PATIENTS


MANAGEMENTMANAGEMENT (contd.) (contd.)

23 (34%) PATIENTS – 2 OR MORE 23 (34%) PATIENTS – 2 OR MORE ASPIRATIONSASPIRATIONS

10 (15%) PATIENTS – PRIMARY EXCISION10 (15%) PATIENTS – PRIMARY EXCISION

19 (28%) PATIENTS – EXCISION FOLLOWING 19 (28%) PATIENTS – EXCISION FOLLOWING ASPIRATION ASPIRATION


MANAGEMENT (CONTD.)MANAGEMENT (CONTD.)

PRIMARY MODALITY OF TREATMENTPRIMARY MODALITY OF TREATMENT

INFRATENTORIAL ABSCESSES– INFRATENTORIAL ABSCESSES– EXCISIONEXCISION

SUPRATENTORIAL ABSCESSES - BURR SUPRATENTORIAL ABSCESSES - BURR HOLE ASPIRATIONHOLE ASPIRATION


PRE TAPPING POST TAPPING

BASAL GANGLIA ABSCESS


POSTERIOR FOSSA ABSCESS SUB DURA EMPYMA


HOSPITAL STAYHOSPITAL STAY

AVERAGE HOSPITAL STAY – 12 DAYSAVERAGE HOSPITAL STAY – 12 DAYS

MINIMUM STAY – 4 DAYSMINIMUM STAY – 4 DAYS

MAXIMUIM STAY – 32 DAYSMAXIMUIM STAY – 32 DAYS


FOLLOW UPFOLLOW UP

AVAILABLE FOR 51 (76%) PATIENTSAVAILABLE FOR 51 (76%) PATIENTS

AVERAGE FOLLOW UP 5.6 MONTHSAVERAGE FOLLOW UP 5.6 MONTHS

(RANGE 1 MONTH – 24 MONTHS)(RANGE 1 MONTH – 24 MONTHS)


SEQUELAESEQUELAE

14 (21%) - HYDROCEPHALUS 14 (21%) - HYDROCEPHALUS

4 PATIENTS REQUIRED SHUNT 4 PATIENTS REQUIRED SHUNT PLACEMENTPLACEMENT

7 (10%) – SEIZURES7 (10%) – SEIZURES

2 (3%) – DIED 2 (3%) – DIED

(BOTH HAD SUBDURAL EMPYMA)(BOTH HAD SUBDURAL EMPYMA)


SEQUELAE


CONCLUSIONSCONCLUSIONS

- We prefer primary excision of abscess We prefer primary excision of abscess in Infratentorial compartment and in Infratentorial compartment and Aspiration in other regions.Aspiration in other regions.

- Tuberculosis should be strongly Tuberculosis should be strongly suspected in all cases and searched suspected in all cases and searched for.for.

- Hydrocephalus can develop in a Hydrocephalus can develop in a number of successfully treated number of successfully treated patients(21%in our series), patients(21%in our series), though only a small percentage though only a small percentage will require shunt placement.will require shunt placement.


CONCLUSIONSCONCLUSIONS (Contd.) (Contd.)

profile of brain abscesses in pediatric population at aiims agrawal d., mahapatra a.k., suri a....

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