A gas forming brain abscess that was resistant to treatment with antibiotics, blycerol, and steroids is reported. A CT scan showed a frontal epidural gas shadow which progressed in 3 weeks to massive frontal cerebritis with gas within the abscess, ventricle, and basal cisterns. An anaerobic culture of CSF revealed peptostreptococus, which was been increasing recently as a causative organism in brain abscess. We feel that the primary management of brain abscess should be surgical excision followed by appropriate antibiotic therapy.
Abscess ; Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Peptostreptococcus* ; Steroids ; Tomography, X-Ray Computed

OBJECTIVE: Spontaneous intracranial hypotension(SIH) is a rare condition presented with cardinal postural headache and low CSF pressure. The authors describe the characteristic clinical features, imaging findings, and treatment methods in the patients with spontaneous intracranial hypotension. METHODS: Between May 1994 and Aug. 2001, eight patients were diagnosed with spontaneous intracranial hypotension based on characteristic radiologic and clinical findings in our department. All cases were shown diffuse meningeal enhancement(DME) on magnetic resonance(MR) image. Two cases had subdural hematoma. RESULTS: The most characteristic feature on Brain MR image is DME with/without subdural fluid collection. Radionuclide image reveals direct leaking point and rapid appearance of urinary bladder activity. Direct leaking points were detected in all four cases who performed radioisotope study. Autologous epidural blood patches were applied to four cases, and all of them were improved without complication. Among four patients treated with conservative method, three were improved, but one patient was died of spontaneous chronic subdural hematoma. CONCLUSION: We suggest that 1) meticulous studies need to be performed aggressively if SIH is diagnosed clinically and radiologically, 2) the most effective study may be radioisotope study, and 3) if leaking point is found, aggressive management such as autologous epidural blood patches is recommended.
Blood Patch, Epidural ; Brain ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Intracranial Hypotension* ; Urinary Bladder