Brain stem abscesses in childhood

• Published in: Child's nervous system Vol. 21; no. 1; pp. 27 - 31
• Main Authors: Suzer, T, Coskun, E, Cirak, B, Yagci, B, Tahta, K
• Format: Journal Article
• Language: English
• Published: Germany 01.01.2005
• Subjects: Brain Abscess - diagnostic imaging; Brain Abscess - physiopathology; Brain Abscess - surgery; Brain Stem - diagnostic imaging; Brain Stem - microbiology; Brain Stem - pathology; Brain Stem - surgery; Child; Drainage - methods; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging - methods; Neurologic Examination; Radionuclide Imaging; Review Literature as Topic; Stereotaxic Techniques; Treatment Outcome
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-004-1024-1

Solitary brain stem abscess is a rare condition with high mortality and morbidity. These lesions were considered to be invariably fatal before 1974 when advanced diagnostic tools were not available. Recently, the diagnosis and prognosis of brain stem abscesses have been modified by the introduction of modern radiological tools, and several patients with a favorable outcome have been reported since then. Because the pons is the most common site of the abscesses, involvement of the sixth and seventh nerves is frequent. The midbrain is the second most likely location, and medullary abscesses are distinctly rare. Treatment of a brain stem abscess includes medical therapy alone, open microsurgical intervention, or stereotactic aspiration. We report a case of a 7-year-old girl with a solitary brain stem abscess. Her neurological examination revealed involvement of the cranial nerves and pyramidal tracts. Microsurgical exposure and aspiration of the abscess resulted in rapid improvement in her neurological condition and radiological resolution of the lesion. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment, and we review the relevant literature.