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PO07-MO-08 A case of paranasal sinusitis-associated meningoencephalitis presenting as frontal scalp abscess
S186
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
PO07-MO-07 The study of microbiology of brain abscess G. Eslami, F. Fallah, M. Lotfi, S. Taheri, N. Faramarzi. Shahid Beheshti University, MC, Tehran, Islamic Republic of Iran Purpose: Brain abscess is a Focal collection within the brain parenchyma. Despite the technological advancements in diagnostic and neurosurgical procedures, brain abscess continues to remain a potentially fatal central nervous system infection. In a descriptive study, we evaluated 30 cases of brain abscess were treated at Loghman Hakim hospital from march 2003 to December 2007. Method: Out of 30 patients 20 (66.7%) were males and 10 (33.3%) females. Mean age was 32 years (range 8 years to 70 years). There was a peak at 20 to 29 years. Predisposing factors were identified in 20 (66/7%) patients. The common predisposing factors were otic infection (26.7%), I.V drug using (16.7), neurosurgery (13.3%) and penetrating head trauma (6.7%). The most frequent presenting signs and symptoms were headache (73.3%), nausea and vomiting (70%), fever (50%), focal neurologic deficits (50%) and mental status changes (46.7%). Triad of fever, headache and focal deficit were seen in 20% of patients. Solitary abscess was found in 70% of the cases while in 30% of the cases multiple abscess were found. Frontal lobe and parietal lobe were the commonest sites involved. Cultures were found positive for microorganism in 66.7% of the cases. 45% of which were aerobic and 55% anaerobic bacteria. Staphylococci (30%), peptostreptococcus (25%), bacteroids (20%) and streptococcus (15%) were the commonest isolates. Third generation cephalosporins and metronidazole and vancomycin were used most often for empirical therapy. Burr hole aspiration was done in only 50% of the cases. Over all mortality was 23.3% in this series. Mortality rate was 33.3% in patients with medical treatment. PO07-MO-08 A case of paranasal sinusitis-associated meningoencephalitis presenting as frontal scalp abscess J.Y. Cho1 , O.H. Kwon2 , K.S. Park3 . 1 Neurology, Ilsan Paik Hospital, Inje University College of Me, Goyang, Republic of Korea; 2 Neurology, Eulji General Hospital, Eulji University College, Seoul, Republic of Korea; 3 Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Background: While complications of paranasal sinusitis are well documented, they remain relatively uncommon due to the introduction of antibiotics. Delays in diagnosis and treatment can occur and may result in extracranial or intracranial complications, because signs and symptoms of acute sinusitis may be absent. We report a patient with frontal scalp abscess as a complication of minimally symptomatic paranasal sinusitis. Case Report: A previous healthy 22-year-old man was brought to our hospital for reported headache, and a rash over the left forehead. At that time, the patient was sent home with a presumptive diagnosis of a herpes infection. The patient returned a few days later to outpatient department for reported fever of 37.4 degrees centigrade, severe headache and a progressive tender swelling with rash of the left frontal area. No deterioration in the patient’s neurological status was noticed, WBC count was 18,000 per microliter. A MRI scan of the brain was done, which revealed a left frontal sinusitis, abscess formation in the left frontal scalp and combined meningoencephalitis in the left frontal area. There were soft tissue densities and mucoperosteal thickening in the left maxillary, ethmoid and frontal sinuses. Medications at the time of admission include vancomycin and ceftriaxone. The patient underwent irrigation and drainage of the subgaleal abscess by neurosurgeon. Culture of the abscess grew Streptococcus viridans. The antibiotic regimen was changed from vancomycin to metronidazole. The patient was discharged home on postoperative day 22 without any neurological sequelae.
Conclusions: The case shows the rapid progression of subgaleal abscess complicated with paranasal sinusitis, which requires prompt diagnosis and management. PO07-MO-09 A case report of a 42-year-old Thai woman with multiple brain abcesses caused by Listeria monocytogenes A. Pisarnpong1 , P. Boonma2 , S. Sukumalchantra3 , S. Nuntaaree4 , O. Chawalparit5 , S. Sachthep6 . 1 Brain Center, Bangkok Hospital Medical Center, Bangkok, Thailand; 2 Infectious Unit, Department of Medicine, Bangkok Hospital Medical Center, Bangkok, Thailand; 3 Nephrology Unit, Department of Medicine, Bangkok Hospital Medical Center, Bangkok, Thailand; 4 Deparment of Neurosurgery, Siriraj Hospital, Bangkok, Thailand; 5 Radiology Department, Siriraj Hospital, Bangkok, Thailand; 6 Rheumatology Unit, Bangkok Hospital Medical Center, Bangkok, Thailand Purpose: Listeria monocytogenes is an uncommon cause of central nervous system (CNS) infection in general population but it is an important cause of CNS infection in immunocompromised host. Meningitis is the most common manifestation while brain abcess occurs in about 1% of the patients and usually solitary. Method: We would like to report a case of 42-year-old Thai woman who has underlying of lupus nephritis and has been taking long term prednisolone and has been admitted into the hospital due to fever, severe headache, deterioration of consciousness and progressive left hemiplegia. Results: Magnetic resonance imaging of the brain demonstrated multiple small brain abcesses, wide spread in right hemisphere involving in different areas including brain stem and frontotemporo-pariatal lobes. Listeria monocytogenes was found in cerebrospinal fluid culture. Conclusions: CNS infection caused by listeria monocytogenes even rare but can present with multiple small brain abcesses and treatment with high doses intravenous ampicillin is considered treatment of choice. PO07-MO-10 Rhinocerebral mucormycosis: a case report M.I. Miladi1 , M. Damak1 , A. Kallel1 , I. Feki1 , N. Elleuch1 , A. Boukhriss1 , M. Ben Jemaa2 , C. Mhiri1 . 1 Neurology, Habib Bourguiba Hospital, SFAX, Tunisia; 2 Department of Infectious Diseases, Hedi Chaker Hospital, SFAX, Tunisia Mucormycosis is a rare and acute opportunistic infection which is frequently lethal, usually observed in immunocompromised people such as non-controlled diabetic patients. The infection usually begins in the nose but it can invade the lung, the digestive tract, and the skin. We report the case of a 66-year-old diabetic man, with chronic renal failure, hypertension and coronary artery disease presenting with acute painful ptosis and swelling of left eye and fever. Physical examination showed a complete ophthalmoplegia of the left eye and dark nasal eschar. The cerebral magnetic resonance imaging showed the extensive involvement of bilateral ethmoidal sinuses. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Our patient was treated by amphotericin B but he developed an intra cerebral abscess with fatal evolution. This observation provides on opportunity to recall clinical, histopathological, and therapeutic aspects of rhinocerebral mucormycosis. PO07-MO-11 Rhino-orbital-cerebral mucormycosis with diabetic ketoacidosis: a case report M.D. Kritsada Rodprasert. Neurology Division, Medicine Department, Ratchaburi Hospital, Ratchaburi, Thailand Mucormycosis often develops in immunocompromised patients, particularly in patient with diabetic ketoacidosis. Unless early
19th World Congress of Neurology, Poster Abstracts / Journal of the Neurological Sciences 285 S1 (2009) S155–S339
PO07-MO-07 The study of microbiology of brain abscess G. Eslami, F. Fallah, M. Lotfi, S. Taheri, N. Faramarzi. Shahid Beheshti University, MC, Tehran, Islamic Republic of Iran Purpose: Brain abscess is a Focal collection within the brain parenchyma. Despite the technological advancements in diagnostic and neurosurgical procedures, brain abscess continues to remain a potentially fatal central nervous system infection. In a descriptive study, we evaluated 30 cases of brain abscess were treated at Loghman Hakim hospital from march 2003 to December 2007. Method: Out of 30 patients 20 (66.7%) were males and 10 (33.3%) females. Mean age was 32 years (range 8 years to 70 years). There was a peak at 20 to 29 years. Predisposing factors were identified in 20 (66/7%) patients. The common predisposing factors were otic infection (26.7%), I.V drug using (16.7), neurosurgery (13.3%) and penetrating head trauma (6.7%). The most frequent presenting signs and symptoms were headache (73.3%), nausea and vomiting (70%), fever (50%), focal neurologic deficits (50%) and mental status changes (46.7%). Triad of fever, headache and focal deficit were seen in 20% of patients. Solitary abscess was found in 70% of the cases while in 30% of the cases multiple abscess were found. Frontal lobe and parietal lobe were the commonest sites involved. Cultures were found positive for microorganism in 66.7% of the cases. 45% of which were aerobic and 55% anaerobic bacteria. Staphylococci (30%), peptostreptococcus (25%), bacteroids (20%) and streptococcus (15%) were the commonest isolates. Third generation cephalosporins and metronidazole and vancomycin were used most often for empirical therapy. Burr hole aspiration was done in only 50% of the cases. Over all mortality was 23.3% in this series. Mortality rate was 33.3% in patients with medical treatment. PO07-MO-08 A case of paranasal sinusitis-associated meningoencephalitis presenting as frontal scalp abscess J.Y. Cho1 , O.H. Kwon2 , K.S. Park3 . 1 Neurology, Ilsan Paik Hospital, Inje University College of Me, Goyang, Republic of Korea; 2 Neurology, Eulji General Hospital, Eulji University College, Seoul, Republic of Korea; 3 Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea Background: While complications of paranasal sinusitis are well documented, they remain relatively uncommon due to the introduction of antibiotics. Delays in diagnosis and treatment can occur and may result in extracranial or intracranial complications, because signs and symptoms of acute sinusitis may be absent. We report a patient with frontal scalp abscess as a complication of minimally symptomatic paranasal sinusitis. Case Report: A previous healthy 22-year-old man was brought to our hospital for reported headache, and a rash over the left forehead. At that time, the patient was sent home with a presumptive diagnosis of a herpes infection. The patient returned a few days later to outpatient department for reported fever of 37.4 degrees centigrade, severe headache and a progressive tender swelling with rash of the left frontal area. No deterioration in the patient’s neurological status was noticed, WBC count was 18,000 per microliter. A MRI scan of the brain was done, which revealed a left frontal sinusitis, abscess formation in the left frontal scalp and combined meningoencephalitis in the left frontal area. There were soft tissue densities and mucoperosteal thickening in the left maxillary, ethmoid and frontal sinuses. Medications at the time of admission include vancomycin and ceftriaxone. The patient underwent irrigation and drainage of the subgaleal abscess by neurosurgeon. Culture of the abscess grew Streptococcus viridans. The antibiotic regimen was changed from vancomycin to metronidazole. The patient was discharged home on postoperative day 22 without any neurological sequelae.
Conclusions: The case shows the rapid progression of subgaleal abscess complicated with paranasal sinusitis, which requires prompt diagnosis and management. PO07-MO-09 A case report of a 42-year-old Thai woman with multiple brain abcesses caused by Listeria monocytogenes A. Pisarnpong1 , P. Boonma2 , S. Sukumalchantra3 , S. Nuntaaree4 , O. Chawalparit5 , S. Sachthep6 . 1 Brain Center, Bangkok Hospital Medical Center, Bangkok, Thailand; 2 Infectious Unit, Department of Medicine, Bangkok Hospital Medical Center, Bangkok, Thailand; 3 Nephrology Unit, Department of Medicine, Bangkok Hospital Medical Center, Bangkok, Thailand; 4 Deparment of Neurosurgery, Siriraj Hospital, Bangkok, Thailand; 5 Radiology Department, Siriraj Hospital, Bangkok, Thailand; 6 Rheumatology Unit, Bangkok Hospital Medical Center, Bangkok, Thailand Purpose: Listeria monocytogenes is an uncommon cause of central nervous system (CNS) infection in general population but it is an important cause of CNS infection in immunocompromised host. Meningitis is the most common manifestation while brain abcess occurs in about 1% of the patients and usually solitary. Method: We would like to report a case of 42-year-old Thai woman who has underlying of lupus nephritis and has been taking long term prednisolone and has been admitted into the hospital due to fever, severe headache, deterioration of consciousness and progressive left hemiplegia. Results: Magnetic resonance imaging of the brain demonstrated multiple small brain abcesses, wide spread in right hemisphere involving in different areas including brain stem and frontotemporo-pariatal lobes. Listeria monocytogenes was found in cerebrospinal fluid culture. Conclusions: CNS infection caused by listeria monocytogenes even rare but can present with multiple small brain abcesses and treatment with high doses intravenous ampicillin is considered treatment of choice. PO07-MO-10 Rhinocerebral mucormycosis: a case report M.I. Miladi1 , M. Damak1 , A. Kallel1 , I. Feki1 , N. Elleuch1 , A. Boukhriss1 , M. Ben Jemaa2 , C. Mhiri1 . 1 Neurology, Habib Bourguiba Hospital, SFAX, Tunisia; 2 Department of Infectious Diseases, Hedi Chaker Hospital, SFAX, Tunisia Mucormycosis is a rare and acute opportunistic infection which is frequently lethal, usually observed in immunocompromised people such as non-controlled diabetic patients. The infection usually begins in the nose but it can invade the lung, the digestive tract, and the skin. We report the case of a 66-year-old diabetic man, with chronic renal failure, hypertension and coronary artery disease presenting with acute painful ptosis and swelling of left eye and fever. Physical examination showed a complete ophthalmoplegia of the left eye and dark nasal eschar. The cerebral magnetic resonance imaging showed the extensive involvement of bilateral ethmoidal sinuses. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Our patient was treated by amphotericin B but he developed an intra cerebral abscess with fatal evolution. This observation provides on opportunity to recall clinical, histopathological, and therapeutic aspects of rhinocerebral mucormycosis. PO07-MO-11 Rhino-orbital-cerebral mucormycosis with diabetic ketoacidosis: a case report M.D. Kritsada Rodprasert. Neurology Division, Medicine Department, Ratchaburi Hospital, Ratchaburi, Thailand Mucormycosis often develops in immunocompromised patients, particularly in patient with diabetic ketoacidosis. Unless early