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7 results

  • Review of management practices of sinogenic intracranial abscesses in children

  • K Milinis, J Thiagarajan, S Leong, S De, A Sinha, R Sharma, S Sharma
  • Journal:
    The Journal of Laryngology & Otology / Volume 137 / Issue 10 / October 2023
    Published online by Cambridge University Press:
    08 February 2023, pp. 1135-1140
    Print publication:
    October 2023
    • Article
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  • Objective

    This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration.

    Method

    This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months.

    Results

    A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes.

    Conclusion

    Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.

  • Chapter 25 - Epidural Analgesia

  • from Part 5 - Central Nervous System
  • Edited by Hugh Montgomery, Robert Shulman, Mayur Murali
  • Book:
    Surviving Prescribing
    Published online:
    08 June 2020
    Print publication:
    25 June 2020, pp 101-104

  • Summary

    Epidural analgesia is a safe and effective method of providing pain relief before, during and after a surgical procedure, or for patients with chronic pain, using a combination of local anaesthetic and opioids. The choice of agent, contraindications and complications of epidural analgesia are discussed, and the reader is also provided with top tips for prescribing epidurals.

  • Holocord spinal epidural abscess in a pregnant patient presenting as premature labour: a rare presentation of an unusual diagnosis

  • Kirsteen R. Burton, Xi Wang, Deljit Dhanoa
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 16 / Issue 4 / July 2014
    Published online by Cambridge University Press:
    04 March 2015, pp. 334-338
    Print publication:
    July 2014
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  • Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despiteextensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.

  • Chapter 16 - Ethical issues in hospitalist and inpatient neurology

  • Edited by S. Andrew Josephson, University of California, San Francisco, W. David Freeman, David J. Likosky
  • Book:
    Neurohospitalist Medicine
    Published online:
    07 October 2011
    Print publication:
    29 September 2011, pp 203-212

  • Summary

    This chapter provides a practical guide for clinicians evaluating patients with suspected central nervous system (CNS) infections. Emphasis is placed on common presentations, differential diagnosis, confirmatory testing, initial treatment options, and monitoring response to therapy. Acute bacterial meningitis is characterized by headache, fever, and neck stiffness. Nausea, vomiting, photophobia and seizures are common. Aseptic meningitis is a nonspecific term applied historically to patients with meningitis and negative blood and cerebrospinal cultures. Encephalitis involves brain parenchyma; fever and altered mentation are the predominant presenting symptoms. Brain abscesses are space-occupying CNS lesions which, depending on size and location, may cause focal neurological deficits. Epidural abscess is a neurological emergency. Neurological complications of HIV infection are common and have evolved with introduction of newer therapies. Patients are now living longer with HIV, and CNS pathogens have largely been replaced by HIV-associated cognitive impairment and peripheral neuropathy.

  • Chapter 90 - The menstrual cycle and catamenial epilepsy

  • from Section 4 - Provoked epilepsies
  • Edited by Simon D. Shorvon, Frederick Andermann, Renzo Guerrini
  • Book:
    The Causes of Epilepsy
    Published online:
    05 March 2012
    Print publication:
    14 April 2011, pp 635-642

  • Summary

    This chapter discusses the burden and the changing epidemiology of acute bacterial meningitis (ABM) and the incidence of epilepsy following ABM and intracranial abscesses in children. It identifies the predictive factors, therapeutic implications, and prevention of ABM and consequent epilepsy in these conditions. Of the acquired causes, central nervous system (CNS) infections are common in childhood and include bacterial meningitis, viral encephalitis, and intracranial suppurative infections such as brain abscess, subdural empyema, and cranial epidural abscess. The changing epidemiology of bacterial meningitis and the emergence of antibiotic resistant strains of pneumococcal meningitis demand regional guidelines for initial empirical treatment of ABM based on the knowledge of regional epidemiologic factors. The effectiveness of administration of dexamethasone before the first effective parenteral antibiotic dose in reducing neurologic and/or audiologic sequelae in children with Haemophilus influenzae type B (HiB) meningitis has been demonstrated in several studies.

  • Intracranial hypertension secondary to sigmoid sinus compression by group A streptococcal epidural abscess

  • J P Ludemann, K Poskitt, A Singhal
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 1 / January 2010
    Published online by Cambridge University Press:
    03 August 2009, pp. 93-95
    Print publication:
    January 2010
  • Objective:

    We present an extremely rare case of severe intracranial hypertension secondary to sigmoid sinus compression by a group A streptococcal epidural abscess.

    Method:

    Case report and review of the world literature.

    Results:

    A five-year-old boy was treated for acute otitis media and group A streptococcal bacteraemia, but subsequently developed severe intracranial hypertension. Computed tomography revealed that, although the sigmoid sinuses were not thrombosed, the patient had a dominant right sigmoid sinus that was almost completely compressed by a small epidural abscess. After surgical decompression of the epidural abscess, with aggressive debridement of the granulation tissue from the sigmoid sinus wall, the patient awoke from general anaesthesia with complete resolution of his symptoms and signs of intracranial hypertension. He suffered no sequelae over the subsequent six months' follow up.

    Conclusion:

    This is the first reported case of intracranial hypertension due to an epidural abscess causing sigmoid sinus compression without thrombosis. This case illustrates the fact that, even in the absence of thrombosis of the sigmoid sinus, a small epidural abscess may require urgent surgical treatment.