Burr-Hole Aspiration For Abscess :
Three cases of brain abscess caused by Actinomyces israelii are reported which were successfully treated by burr hole aspiration and a short course of antibiotics (3-4 weeks). The clinical response of the patients, as well as the serial serum C-reactive protein levels and CT findings were used as a guideline for stopping antimicrobial therapy relatively early.
Material And Methods
The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route.
Onset may be sudden or subacute over several weeks :
- Common presenting symptoms include fever, headache, changes in mental state (drowsiness, confusion), focal neurological deficits, grand-mal seizures, nausea and vomiting, neck stiffness.
- A suddenly worsening headache, followed by emerging signs of meningism is often associated with rupture of the abscess.
- Focal motor or sensory deficits
- Raised blood pressure and bradycardia associated with raised intracranial pressure
- Confusion, drowsiness
- Bulging fontanelle in infants
- Intracerebral abscesses may rupture into the ventricular system and produce ventriculitis.
- Epilepsy occurs in around 30%, particularly with temporal lobe abscess and subdural empyema. Anticonvulsants may be required.
- Mainly depending on the speed of diagnosis and treatment, 20-80% of survivors have neurological sequelae, e.g. hemiparesis, visual field loss.
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