Dados do Trabalho
GIANT BRAIN ABSCESS IN A 4-YEAR-OLD CHILD: A CASE REPORT
Apresentação do caso
Brain abscesses (BA) are uncommon in pediatric patients, with an estimated incidence of cases of 0.5/100,000 children. The temporoparietal region is commonly affected by intraparenchymal abscesses. On average, they may have an estimated diameter of 4.5 cm, but the definition of a giant brain abscess has not yet been described. The objective is to report a pediatric patient giant brain abscess.
Male patient with severe idiopathic hydrocephalus at birth who was treated with ventriculoperitoneal shunt. Four episodes of ventriculitis. After antibiotic therapy and shunt changes, he remained stable for a long period with significant cognitive-motor delay and epilepsy that was controlled. CT-Scans were periodically performed and, at the age of 4 years, an image suggestive of a large-volume abscess was observed, involving 2/3 of the intracranial space. Conservative treatment was chosen due to clinical stability and the impossibility of complete drainage of the lesion.
Considering BA, most commonly affected site is the temporoparietal region. The diameter varies between 1.8 cm and 7.2 cm, resulting in a mean diameter of 4.5 cm. There are no reports in the literature describing abscesses measuring 2/3 of the cranial volume. BA <2.5 cm are usually treated with antibiotics, avoiding surgical risks, and in BA >3 cm, surgery is recommended. However, there is no classification conserning BA size in literature. As well as there is no defined recomendation for management of giant BA. Possible drainage complications include meningitis, subdural effusion, seizures, and cerebral edema, but specific complications arising from draining BA of this magnitude have not been reported. In view of the significant cognitive-motor delay already presented by the patient, the absence of signs and symptoms and the clinical stability, in this case, the conservative approach with antibiotic therapy was chosen.
Studies focused on the management of giant BA and post-surgical complications are needed, as there are no specific protocols for managing giant BA. It is essential to assess the risk-benefit of the surgical intervention to prevent complications, since they can cause the patient's clinical instability.
Referências (se houver)
Brain Abscess; Cerebral Ventriculitis; Meningitis
Fonte de Fomento (se houver)
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Felipe Oliveira Santos, Vinícius Carvalho Oliveira, Maria Eduarda Araújo Mendes Vieira, Amanda Castro Oliveira, Barbara Cavalcante Cavalcante Barbosa, Igor Virgílio Carvalho Matias, José Gilberto Brito Henriques