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Brain Abscess in Children: Best article 2025

Risk Factors for Brain Abscess in Children

Brain abscesses are focal, suppurative infections within the brain parenchyma, often resulting from a localized or systemic infection. Risk factors include:

  1. Congenital Heart Disease (CHD): Especially cyanotic CHD, which allows right-to-left shunting, bypassing pulmonary filtration and enabling bacterial emboli to reach the brain.
  2. Chronic Ear, Sinus, or Mastoid Infections: These infections can extend intracranially through direct or hematogenous spread.
  3. Dental Infections: Poor oral hygiene or dental abscesses may serve as a source of infection.
  4. Immunocompromised State: Conditions like HIV, malignancy, or prolonged steroid use impair immune defenses.
  5. Cranial Trauma or Surgery: Trauma leading to skull fractures or surgical interventions increases the risk of introducing pathogens.
  6. Neurocutaneous Syndromes: Conditions like Osler-Weber-Rendu syndrome predispose to vascular anomalies that facilitate abscess formation.
  7. Foreign Body: Presence of a ventriculoperitoneal (VP) shunt or other indwelling devices.

Investigations for Brain Abscess

The diagnosis of a brain abscess relies on clinical suspicion combined with imaging and laboratory findings. Key investigations include:

  1. Neuroimaging:
    • MRI with Contrast: Preferred modality due to superior resolution and ability to differentiate abscess from other lesions.
    • CT Scan with Contrast: Useful in emergency settings to detect ring-enhancing lesions with central necrosis and surrounding edema.
  2. Laboratory Studies:
    • Complete Blood Count (CBC): Often reveals leukocytosis.
    • C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR): Elevated in most cases.
    • Blood Cultures: Essential for identifying the causative organism in hematogenous spread.
  3. Microbiological Analysis:
    • Aspiration or biopsy of the abscess for Gram staining, culture, and sensitivity to guide targeted antibiotic therapy.
  4. Lumbar Puncture: Generally contraindicated in brain abscess due to the risk of brain herniation.
  5. Electroencephalogram (EEG): May be indicated in patients with seizures to localize the focus.

Treatment of Brain Abscess in Children

Management involves a combination of medical and surgical approaches:

  1. Antibiotic Therapy:
    • Empiric Antibiotics: Begin immediately based on the suspected source of infection. Common regimens include:
      • Ceftriaxone or Cefotaxime (for Gram-negative coverage).
      • Metronidazole (for anaerobic organisms).
      • Vancomycin (for Gram-positive coverage, especially MRSA).
    • Duration: Typically 4-8 weeks, tailored based on clinical and radiologic improvement.
  2. Surgical Intervention:
    • Aspiration or Excision: Indicated for large abscesses (>2.5 cm), those causing significant mass effect, or cases unresponsive to antibiotics.
    • Stereotactic Aspiration: Minimally invasive and effective for abscess drainage.
  3. Management of Complications:
    • Seizures: Treated with antiepileptic drugs like levetiracetam.
    • Increased Intracranial Pressure (ICP): Managed with measures like head elevation, hyperosmolar therapy, or surgical decompression.
  4. Supportive Care:
    • Monitoring in an intensive care unit for neurologic and hemodynamic stability.
    • Adequate hydration and nutrition.
  5. Follow-up:
    • Regular imaging to monitor resolution.
    • Address underlying predisposing conditions to prevent recurrence.

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