Multiple brain abscesses in an extremely preterm infant and a 12-year follow up: a case report | Italian Journal of Pediatrics

There are only a few case reports about brain abscesses in EP infants [4,5,6,7,8]. To our knowledge, this is the first case report of an EP infant with a long- term follow-up. Brain abscesses were identified by MRI in this case and were treated by 7-week of systemic antibiotics and early surgical aspirations. With follow-up, MRI showed encephalomalacia in the frontal and parietal lobes of the right hemisphere and bilateral periventricular leukomalacia, but the girl had no obvious neurological deficits based on multiple aspects of examination.

With the development of neuroimaging, neurosurgery, and effective antibiotics, the mortality of brain abscesses has declined in children [2, 9,10,11,12,13]. However, rate of adverse neurological sequelae remains high [2, 9,10,11,12]. With increasing survival, more attentions are needed to improve the prognosis. Prognosis largely depends on early diagnosis and treatment [10]. Brain abscesses are found more frequently in cases of neonatal meningitis and septicemia [2], however, they can be diagnosed without meningitis and the positive rate of blood cultures was low [5, 14, 15]. This patient’s blood culture and cerebrospinal fluid examination were all negative. Furthermore, the lack of the evaluation of catheter-related bloodstream infection was our limitation in the case. Sundaram V. et al., proposed that serial cranial ultrasonograms may be required in septic neonates, to facilitate early identification of brain abscesses [14]. Repeated ultrasonograms performed at bedside should be routine procedure in septic neonates. In this case, brain abscesses were unexpected findings on MRI and serial brain ultrasound performed after the septic episode would have allowed an even earlier diagnosis. However, small abscesses and subdural collections may be missed by ultrasonography [16]. CT scan and MRI results are also important to make the diagnosis and to establish the treatment strategy.

This patient was treated with 7-week antibiotics and received surgical aspiration twice. The first aspiration was performed 9 days after the brain abscesses detected by MRI. Previous study has recommended an aggressive surgical approach of all abscesses larger than 2.5 cm in diameter, combined with 6–8 weeks of intravenous antibiotics [17]. Currently, the major surgical procedure used to treat them is drainage and aspiration, excision being of secondary importance [15]. Compared with aspiration, the scars of central nervous system and epilepsy are more common after excision [18]. Besides, early intervention of surgical procedure is essential to the good outcome [2, 10]. Delayed surgical drainage has high morbidity and mortality [10].

Previous studies showed that developing human brain possessed a superior capacity to reorganize after focal lesions [19,20,21]. Comparing to adult brain, reorganization in developing brain is often dramatically more effective and certain brain functions can primarily develop in atypical locations [21]. Guzzetta A. et al., showed that for the patients diagnosed with congenital hemiplegia, somato-sensory function was generally reorganized within the affected hemisphere [22]. In this case, MRI showed encephalomalacia in the frontal and parietal lobes of the right hemisphere and bilateral periventricular leukomalacia. Previous studies showed that if the abscess was in the parietal lobe, it led to hemiparesis and if the abscess was in the frontal lobe, it led to epilepsy [9, 23]. Nevertheless, the girl had no obvious neurological deficits. We presume the patient could have benefit from a reorganization of the neural network. But further methods are needed to study the reorganization in this patient.

In this case, we emphasize that using appropriate imaging techniques for early diagnosis of brain abscesses and that having appropriate therapies may improve the prognosis. Furthermore, it was a good case to demonstrate the possible neuroplasticity of brain in an EP infant.

Source link

Back to top button