CLINICAL FEATURES AND OUTCOME OF CEREBRAL ABSCESS IN CONGENITAL HEART DISEASE

Authors

  • Atiq Mehnaz
  • Ahmed Umair Syed
  • Allana Salman Saleem
  • Chishti N Khalid

Abstract

Background: Cerebral abscess is a serious life threatening complication of several diseases. Theobjective of this study was to look at the clinical profile, microbiology and outcome of childrenwith cerebral abscess having an underlying congenital heart disease as compared to otherpredisposing conditions. Methods: Thirty children aged less than 15 years were reviewed. Therewere 15 males and 15 females. The mean age of presentation was 5.6±4.4 years. Results: Theduration of illness at the time of admission was 17.6±24.6 days. Typically patients presented withfever, vomiting, headache and seizures. The predisposing conditions found were cyanoticcongenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%) andno underlying cause was found in 5 (17%) children. The most common microbe in children withcyanotic congenital heart disease was of the Streptococcus milleri group (52%). Computerizedtomography confirmed the diagnosis and the most common location of the abscess was theparietal lobe of the cerebral hemisphere. All abscesses were large, more than 2 cm in diameter andwere aspirated surgically. Excision was performed in 6 children. Five children expired, one due toa intracranial bleeding and the others due to severe cerebral edema and tentorial herniation.Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizuredisorder in 5. Conclusion: Brain abscess is a serious infection with poor outcome if diagnosedlate. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosisshould be low particularly in children with a predisposing condition like cyanotic congenital heartdisease.Key words: Brain abscess, cyanotic congenital heart disease

References

Brook I. Brain abscess in children; microbiology and

management. J Child Neurol 1995; 10(4): 283-8.

Goodkin HP, Harper MB, Pomeroy SL. Intracranial abscess

in children: Historical trends at Children’s hospital, Boston.

Pediatrics 2004; 111(8):1765-70.

Piper C, Horstkotte B, Arendt G, Strauer BE. Brain abscess

in children with cyanotic heart defects. Z Kardiol 1994;

(3): 188-93.

Parikh S, Bharucha B, Kamdar S, Kshirsagar N.

Polymorphonuclear leucocyte functions in children with

cyanotic and acyanotic heart disease. Indian Pediatr 1993;

(7):883-90.

Malik S, Joshi SM, Kandoth PW, Vengsarkar US.

Experience with brain abscesses. Indian Pediatr 1994; 31(6):

-6.

Takeshita M, Kagawa M, Yonetani H, Izawa M, Yato S,

Nakanishi T, Monma K. Risk factors for brain abscess in

patients with congenital cyanotic heart disease. Neurol Med

Chir 1992; 32(9): 667-70.

Aebi C, Kauffmann F, Schaad UB. Brain abscess in

childhood-long term experience. Eur J Pediatr 1991; 150(4):

-6.

Pit S, Jamal F, Cheak FK. Microbiology of cerebral abscess:

a four year study in Malaysia. J Trop Med Hyg 1993; 96(3):

-6.

Pandian JD, Monma NV, Cherian PJ, Radhakrishnan K.

Brainstem abscess complication tetralogy of Fallot

successfully treated with antibiotics alone. Neurol India 200;

(3): 272-5.

Yang SY. Brain abscess associated with congenital heart

disease. Surg Neurol 1989; 31(3): 129-32.

Puthucheary SD, Parasakthi N. the bacteriology of brain

abscess: a local experience in Malaysia. Trans R Soc Trop

Med Hyg 1990; 84(4): 689-92.

Sineviratne RS, Navasivayam P, Perera S, Wickremasinghe

RS. Microbiology of brain abscess at a neurosurgical unit of

the National Hospital of Sri Lanka. Ceylon Med J 2003;

(1): 14-6.

Weghtman NC, Barnham MRD, Dove M. Streptococcus

milleri group bacteremia in North Yorkshire, England (1989-

. Indian J Med Res 2004; 119 (Suppl): 164-7.

Woo PC. Streptococcus milleri”endocarditis caused by

streptococcus anginosus. Diagn Microbiol Infect Dis 2004;

(2): 81-8.

Kanamori S, Kusano N, Shinzato T, Saito A. The role of

capsule of streptococcus milleri group in its pathogenicity. J

Infect Chemother 2004; 10(2): 105-9.

Yanagihara C, Wada Y, Nishimura Y. Infectious endocarditis

associated with subarachnoid hemorrhage, subdural

hematoma and multiple brain abscesses. Intern Med 2003;

(12): 1244-7.

Guerin P. Cerebral abscess and cyanotic congenital heart

disease. Arch Mal Coeur Vaiss 1997; 90(5): 651-4.

Gosh S, Chandy MJ, Abraham J. Brain abscess and

congenital heart disease. J Indian Med Assoc 1990; 88(11):

-4.

Takeshita M, Kagawa M, Yato S, Izawa M, Onda H,

Takakura K, et al. Current treatment of brain abscess in

patients with congenital cyanotic heart disease. Neurosurgery

; 41(6): 1270-9

Issue

Vol. 18 No. 2 (2006): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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