Brain Abscess with cyanotic heart disease

ABSTRACT

Twenty-eight patients of congenital cyanotic heart disease associated with brain abscess, who underwent neurosurgical intervention over a period of 5 years from June 1995 to June 2000 were reviewed. The mean age was 6.32 +/- 3.2 years [range 3-14 years] with a male preponderance. Patients having the tetralogy of Fallot were 78.57 percent. Abscesses located supratentorially were 49.28 percent with 42.8 percent predominance in the frontal lobe. Eighteen out of 28 patients were polycythemic with a mean haemoglobin of 16.07 +/- 2.7gm percent while their arterial oxygen saturation varied between 64 percent-92 percent. Twenty one patients underwent CT guided burrhole aspiration, under anaesthetist monitored local anaesthesia, with a repeat aspiration in 12 while aspiration was followed by craniotomy and excision of abscess in seven. Seven underwent primary excision. Mortality in patients undergoing craniotomy for excision of abscess was 35.7 percent as compared to burrhole aspiration group of 14.2 percent with an over all mortality of 25 percent. Morbidity in patients who survived surgery and were discharged was 57.42 percent. We found burrhole aspiration under anaesthetist monitored local anaesthesia relatively simple, effective and well tolerated in this particular group of patients. The overall prognosis of brain abscess associated with congenital cyanotic heart disease is poor; therefore early recognition of symptoms of brain abscess becomes mandatory