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Pediatric brain abscesses profile
 

Pediatric brain abscesses profile

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    Pediatric brain abscesses profile Pediatric brain abscesses profile Presentation Transcript

    • PROFILE OF BRAIN ABSCESSES IN PEDIATRIC POPULATION AT AIIMS Deepak Agrawal Department Of Neurosurgery, All India Institute Of medical Sciences, New Delhi-29
    • PROFILE OF BRAIN ABSCESSES
      • EPIDEMIOLOGY
      • TOTAL OF 89 PTS. (JAN.99 - SEP.01)
      • 67 PEDIATRIC
      • 11 (16%) FEMALE
      • 56 (84%) MALE
    • PROFILE OF BRAIN ABSCESSES
      • PRESENTING SIGNS
      • ALTERED SENSORIUM – 19 (28%) CRANIAL NERVE PALSIES
      • VII – 9 (13%)
      • VI – 5 (7.5%)
      • HEMIPARESIS – 14 (21%)
      • NO DEFICITS – 20 (30%)
    • PROFILE OF BRAIN ABSCESSES
      • LOCATION
      • SUPRATENTORIAL – 52 (78%)
      • INFRATENTORIAL – 15 (22%)
    • PROFILE OF BRAIN ABSCESSES
      • ETIOLOGY
      • CYANOTIC HEART DISEASE – 21 (31%)
      • CSOM – 14 (21%)
      • TUBERCULAR – 11 (16%)
      • INFECTED DERMOID – 5 (7.5%)
      • NEONATAL MENINGITIS – 8 (12%)
      • UNKNOWN – 8 (12%)
    • PROFILE OF BRAIN ABSCESSES
      • 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%)
    • PROFILE OF BRAIN ABSCESSES
      • MANAGEMENT
      • A TOTAL OF
      • 85 BURR HOLE ASPIRATIONS AND
      • 29 ABSCESS EXCISIONS WERE DONE IN 67 PATIENTS
    • PROFILE OF BRAIN ABSCESSES
        • MANAGEMENT (contd.)
      • 23 (34%) PATIENTS – 2 OR MORE ASPIRATIONS
      • 10 (15%) PATIENTS – PRIMARY EXCISION
      • 19 (28%) PATIENTS – EXCISION FOLLOWING ASPIRATION
    • PROFILE OF BRAIN ABSCESSES
      • MANAGEMENT (CONTD.)
      • PRIMARY MODALITY OF TREATMENT
      • INFRATENTORIAL ABSCESSES– EXCISION
      • SUPRATENTORIAL ABSCESSES - BURR HOLE ASPIRATION
    • 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
      • HOSPITAL STAY
      • AVERAGE HOSPITAL STAY – 12 DAYS
      • MINIMUM STAY – 4 DAYS
      • MAXIMUIM STAY – 32 DAYS
    • PROFILE OF BRAIN ABSCESSES
      • FOLLOW UP
      • AVAILABLE FOR 51 (76%) PATIENTS
      • AVERAGE FOLLOW UP 5.6 MONTHS
      • (RANGE 1 MONTH – 24 MONTHS)
    • PROFILE OF BRAIN ABSCESSES
      • SEQUELAE
      • 14 (21%) - HYDROCEPHALUS
      • 4 PATIENTS REQUIRED SHUNT PLACEMENT
      • 7 (10%) – SEIZURES
      • 2 (3%) – DIED
      • (BOTH HAD SUBDURAL EMPYMA)
    • PROFILE OF BRAIN ABSCESSES SEQUELAE
    • PROFILE OF BRAIN ABSCESSES
      • 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.
      • 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.)