| ObjectiveAnalyze the infection mechanism of brain abscesses, clinical manifestations, imaging features, etc. Discuss typicality and atypism of brain abscess, choice of treatment beginning and different treatments, to provide basis for clinical work on the diagnosis and treatment and experience.MethodsRetrospective analysis of70brain abscess cases from2011to2014with clinical data： the epidemiology, pathogenesis, position, clinical features, CSF, imaging findings, combined with domestic and foreign literature to analyze characteristics of brain abscess. According to the characteristic of brain abscesses70cases are divided into typical and atypical group and analyze weather it will influence the treatment and hospital stay and prognosis.Results70cases of patients,48cases of male, female in22cases, men are more than women. The number of this group cryptogenic brain abscess up to24patients, followed by18cases of postoperative of cerebral trauma and neurosurgery,28were otogenic brain abscesses,12hematogenous brain abscesses, low immune function in1case. Abscess location:otogentic brain abscesses are located on the same side temporal lobe and cerebellum, postoperative of cerebral trauma and neurosurgery which are all located in the area or adjacent to the location.Clinical manifestations are mainly headache48cases (68.57%), fever,36cases (51.43%),nausea/vomiting24cases (34.29%), neurologic deficits22cases (31.43%), altered consciousness,20cases (28.57%), nuchal rigidity12cases (17.14%), seizures,2case, triad of headache, fever, focal neurologic deficits12cases (17.14%).70cases of22cases underwent lumbar puncture and cerebrospinal fluid examination,16cases prompt infection, cerebrospinal fluid smears and cultures were all negative.43abscess lesions all appeared hyperintense on T2-W1and DWI, and show ADC values consistent with the diagnosis,27cases were no DWI, misdiagnosis of glioma in2cases.Antibiotic therapy alone of14cases, operative treatment of56cases including puncture drainage of37cases, total resection of12cases. Total resection of brain abscess in hospital time was (18.36±10.46) days, puncture drainage group is (25.89±22.43) days, P<0.05.GOS score of total resection group is (4.27±1.02), and puncture drainage group is (4.33±0.93), P>0.05; In therapeutic antibiotics group hospital stays is (18.07±11.02) days, and surgical treatment group is (22.49±25.64) days, P>0.05, GOS score respectively are (4.86±0.58) days,(4.11±1.76) days, P>0.05.According to review the clinical data of70cases admitted to hospital for that day, typicality rating, less than3points in atypical group, greater than or equal to3points into the typical group, a total of16cases of atypical group, a typical group of54cases. Typical group from admission to the clinical intervention (initial antibiotic use or surgery) time interval is (0.63±1.45) days, atypical group interval (2.00±2.14) day, P <0.05, statistically difference. Typical of brain abscess in hospital time was (20.38±10.07) days, atypical group is (24.22±13.82) days, statistically significant. GOS prognostic score have no statistical differences in the two groups.ConclusionBrain abscesses different positions, the diversity of the uncertainty of infection source and clinical manifestation is not typical, some cerebrospinal fluid was no signs of infection, imperfect and not typical of imaging can make brain abscesses misdiagnosis or delay, once clinical suspected brain abscess should immediately to antibiotic treatment. Enhanced MRI+DWI+ADC is brain abscesses valuable diagnostic tool, especially the identification of intracranial cystic, necrosis placeholders. If brain abscesses can get correct diagnosis and treatment, prognosis is good. Surgical complications and abscess is broken into the ventricle is still the important factor affecting the prognosis. |
PDF Full Text Request