Journal article
Pediatric brainstem abscess successfully treated with stereotactic aspiration: illustrative case
Journal of Neurosurgery: Case Lessons, Vol.6(6), CASE23262
08/07/2023
DOI: 10.3171/CASE23262
PMCID: PMC10555595
PMID: 37581585
Abstract
BACKGROUND Pediatric brainstem abscesses are rare entities that account for 1% of all brain abscesses and, when diagnosed, constitute a neurosurgical emergency. OBSERVATIONS A previously healthy 11-year-old male presented with several days of worsening headache, confusion, and ataxia. Brain magnetic resonance imaging (MRI) revealed a midbrain and pons lesion. The patient subsequently had a rapid neurological decline with loss of consciousness and brainstem function. Follow-up MRI revealed significant enlargement of the brainstem lesion with extension into the pons, midbrain, and thalamus, with greater concerns for an abscess rather than a tumor or an inflammatory process. He was taken for an emergent stereotactic aspiration of the abscess, and broad-spectrum antibiotics were initiated. He had neurological improvement, which subsequently declined 5 days later with brain MRI revealing an increase in the brainstem abscess, which required a second stereotactic aspiration. After rehabilitation, he made a significant neurological recovery. LESSONS Pediatric brainstem abscesses are rare pathologies, and a high index of suspicion is needed in patients presenting with a brainstem lesion mimicking tumor but with rapid neurological decline despite no other evidence of infection or infectious/inflammatory markers. Stereotactic aspiration is required for large lesions to target the antibiotic treatment and as an adjunct to broad-spectrum antibiotics.
Details
- Title: Subtitle
- Pediatric brainstem abscess successfully treated with stereotactic aspiration: illustrative case
- Creators
- Nahom Teferi - University of IowaAjmain Chowdhury - University of IowaSarah Lee - University of IowaMeron Challa - University of IowaLukasz Weiner - University of IowaSarah Auerbach - University of IowaMahil RaoBrian J. Dlouhy - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of Neurosurgery: Case Lessons, Vol.6(6), CASE23262
- DOI
- 10.3171/CASE23262
- PMID
- 37581585
- PMCID
- PMC10555595
- NLM abbreviation
- J Neurosurg Case Lessons
- ISSN
- 2694-1902
- eISSN
- 2694-1902
- Language
- English
- Date published
- 08/07/2023
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Orthopedics and Rehabilitation; Neurosurgery; Infectious Disease (Pediatrics)
- Record Identifier
- 9984453216002771
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