PROFILE OF BRAIN ABSCESSES IN PEDIATRIC POPULATION AT AIIMS  Deepak Agrawal Department Of Neurosurgery, All India Institut...
PROFILE OF BRAIN ABSCESSES <ul><li>EPIDEMIOLOGY </li></ul><ul><li>TOTAL OF 89 PTS. (JAN.99 - SEP.01)    </li></ul><ul><li>...
PROFILE OF BRAIN ABSCESSES <ul><li>PRESENTING SIGNS </li></ul><ul><li>ALTERED SENSORIUM – 19 (28%) CRANIAL NERVE PALSIES  ...
PROFILE OF BRAIN ABSCESSES <ul><li>LOCATION </li></ul><ul><li>SUPRATENTORIAL – 52 (78%) </li></ul><ul><li>INFRATENTORIAL –...
PROFILE OF BRAIN ABSCESSES <ul><li>ETIOLOGY </li></ul><ul><li>CYANOTIC HEART DISEASE – 21 (31%) </li></ul><ul><li>CSOM – 1...
PROFILE OF BRAIN ABSCESSES <ul><li>CAUSATIVE ORGANISM </li></ul><ul><li>MSSA – 9 (13%) </li></ul><ul><li>STREP. VIRIDANS –...
PROFILE OF BRAIN ABSCESSES <ul><li>MANAGEMENT  </li></ul><ul><li>A TOTAL OF </li></ul><ul><li>85 BURR HOLE ASPIRATIONS AND...
PROFILE OF BRAIN ABSCESSES <ul><ul><li>MANAGEMENT  (contd.) </li></ul></ul><ul><li>23 (34%) PATIENTS – 2 OR MORE ASPIRATIO...
PROFILE OF BRAIN ABSCESSES <ul><li>MANAGEMENT (CONTD.) </li></ul><ul><li>PRIMARY MODALITY OF TREATMENT </li></ul><ul><li>I...
PROFILE OF BRAIN ABSCESSES PRE TAPPING POST TAPPING BASAL GANGLIA ABSCESS
PROFILE OF BRAIN ABSCESSES POSTERIOR FOSSA ABSCESS SUB DURA EMPYMA
PROFILE OF BRAIN ABSCESSES <ul><li>HOSPITAL STAY </li></ul><ul><li>AVERAGE HOSPITAL STAY – 12 DAYS </li></ul><ul><li>MINIM...
PROFILE OF BRAIN ABSCESSES <ul><li>FOLLOW UP </li></ul><ul><li>AVAILABLE FOR 51 (76%) PATIENTS </li></ul><ul><li>AVERAGE F...
PROFILE OF BRAIN ABSCESSES <ul><li>SEQUELAE </li></ul><ul><li> 14 (21%) - HYDROCEPHALUS  </li></ul><ul><li>4 PATIENTS REQU...
PROFILE OF BRAIN ABSCESSES SEQUELAE
PROFILE OF BRAIN ABSCESSES <ul><li>CONCLUSIONS </li></ul><ul><li>We prefer primary excision of abscess in Infratentorial c...
<ul><li>Hydrocephalus can develop in a number of successfully treated patients(21%in our series), though only a small perc...
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Pediatric brain abscesses profile

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Pediatric brain abscesses profile

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

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