The medical records of fifty-seven patients uith intracranial abscess which had been admitted to the departrnents of neurology, neurosurgery, otolaryngology and pediatrics. In Seoul National University Hospital from 1983 to 1992 were reviewed. Mean age was 31.4 years, ranging from 3 to 66 vears. Male predominated with the ratio of 2.6: 1. Common predisposing conditions were hearrt disease, parameningeal infection such as chronic otitis media, paranasal sinusitis, pulmonary infections in order of frequency. Primary focus was not determined in 16% of cases. A wide range of organisms were encountered and aerobes were more frequently cultivated than anaerobes. In 56% of cases. Pathogens were not confirmed. The use of preoperative antibiotics was not significantly correlated with sterile cultures: Initial symptoms and signs uere usually nonspecific; headache in 89%, fever in 53%. Nausea and vomiting in 54%. Altered consciousness in 39%. Computed tomography was the most accurate and rapid diagnostic tool, and serial follow-up during the treatment was helpful in knowing whether the response to several treatment modalities was good or not. Of the fifty-seven cases, twenty-seven patients were operated; 17 patients underwent aspiration of the abscesses, and ten patients received resection of abscesses. Sixty three percents of surviving patients suffered from neurologic sequelae; most commonly epilepsy in 50%. The mortality rate among all treated patients was significantly related to the initial consciousness level and the number ol the abscesses, but not to the size ol lesion. Identification of organism, age or sex. Although non-surgical therapy is appropriate n some selected patients, surgical intervention should be considered, when the consciousness level deterates or the CT findings are aggravated after full dose of combination antibiotics.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Consciousness ; Epilepsy ; Fever ; Follow-Up Studies ; Headache ; Humans ; Male ; Medical Records ; Mortality ; Nausea ; Neurology ; Neurosurgery ; Otitis Media ; Otolaryngology ; Pediatrics ; Perimeningeal Infections ; Retrospective Studies* ; Seoul ; Sinusitis ; Vomiting

Pott's puffy tumor is a rare clinical entity, which has been described as a subperiosteal abscess in the frontal bone secondary to frontal osteomyelitis. Pott's puffy tumor can be associated with venous thrombosis, epidural abscess, subdural empyema, and brain abscess. In the present paper, we describe our experience of treating a 59-year old man who complained of a headache and a swelling of forehead. Because of bilateral lesion and obstruction of frontal recess, an external approach of the frontal sinus was carried out. To our knowledge, this is the first report of Pott's puffy tumor involving the bilateral frontal sinus.
Abscess ; Brain Abscess ; Empyema, Subdural ; Epidural Abscess ; Forehead ; Frontal Bone ; Frontal Sinus ; Headache ; Osteomyelitis ; Pott Puffy Tumor ; Venous Thrombosis

Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
Abdomen ; Aged ; Brain Abscess ; Diabetes Mellitus ; Empyema, Subdural ; Enterococcus faecalis ; Epidural Abscess* ; Extremities ; Fatal Outcome ; Humans ; Male ; Pelvis ; Spine

Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with the underlying frontal osteomyelitis. It has become a rare disease entity due to the development of antibiotics. Despite its rarity, it must be managed carefully because it is often associated with significant intracranial complications. We described a 12-year-old girl with Pott's puffy tumor accompanied with epidural abscess and subdural empyema, which was considered to be caused by the contralateral frontal sinusitis. To our knowledge, a Pott's puffy tumor caused by contralateral frontal sinusitis has not been reported in the literature. We discuss the clinical presentation and successful treatment of this unique case with brief review of the literature.
Abscess ; Anti-Bacterial Agents ; Child ; Empyema, Subdural ; Epidural Abscess ; Female ; Frontal Bone ; Frontal Sinus* ; Frontal Sinusitis* ; Humans ; Osteomyelitis ; Pott Puffy Tumor* ; Rare Diseases

No abstract available.
Epidural Abscess*

No abstract available.
Epidural Abscess*

PURPOSE: Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging. METHODS: A 28-year-old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels. RESULTS: The postoperative course was uneventful and flap survival was excellent. The infection-resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after the surgery and wound discharge or recurrence was absent during 13 months of follow up periods. CONCLUSION: The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages
Adult ; Arachnoid ; Blood Circulation ; Cerebrum ; Craniotomy ; Debridement ; Empyema, Subdural ; Epidural Abscess ; Female ; Fever ; Follow-Up Studies ; Free Tissue Flaps ; Glucose ; Hematoma, Subdural ; Humans ; Neurosurgery ; Omentum ; Recurrence ; Subdural Space ; Wound Infection

The authors present a case of subdural empyema in a macrocephalic patient. A 23-year-old male was admitted due to headache and fever. One month ago, he had mild head injury by his coworkers. Physical examination showed a macrocephaly and laboratory findings suggested purulent meningitis. Neuroimaging studies revealed a huge size of epidural space-occupying lesion. Under the impression of epidural abscess, operation was performed. Eventually, the lesion was located at subdural space and was proven to be subdural empyema. Later, histological examination of the specimen obtained by surgery demonstrated finings consistent with the capsule of the chronic subdural hematoma. Two weeks after operation, Propionibacterium acnes was isolated. The intravenous antibiotics were used for total of eight weeks under monitoring of the serum level of the C-reactive protein. Follow-up brain computed tomography (CT) scan showed the presence of significant amount of remaining subdural lesion. However, he has complained of minimal discomfort. It is suggested that the subdural empyema occurred with preexisting chronic subdural hematoma after head injury about one month prior to admission and it took a long time to treat Propionibacterium acnes subdural empyema with systemic antibiotics, at least over eight weeks.
Anti-Bacterial Agents ; Brain ; C-Reactive Protein ; Craniocerebral Trauma ; Empyema, Subdural ; Epidural Abscess ; Fever ; Follow-Up Studies ; Headache ; Hematoma, Subdural, Chronic ; Humans ; Macrocephaly ; Male ; Meningitis ; Neuroimaging ; Physical Examination ; Propionibacterium ; Propionibacterium acnes ; Subdural Space ; Young Adult

OBJECTIVE: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. METHODS: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. RESULTS: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. CONCLUSION: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.
Diagnosis ; Empyema, Subdural ; Frontal Lobe ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Pressure ; Lymphangioma, Cystic ; Magnetic Resonance Imaging ; Rabeprazole ; Seizures ; Subdural Effusion*

Subdural empyema of the brain is an uncommon disorder that occurs more frequently in children than in adult. Authors report a very rare of subdural empyema following the subdural hygroma after mild head injury. The exact mechanism of infection is not known. However, we have to consider subdural infection as one of differential diagnosis in elderly patient with subdural hygroma when new abnormal density lesion is developed in the subdural space.
Adult ; Aged ; Brain ; Child ; Craniocerebral Trauma ; Diagnosis, Differential ; Empyema, Subdural ; Escherichia ; Escherichia coli ; Humans ; Subdural Effusion ; Subdural Space