Salmonella enteritidis brain abscess in a sickle cell disease patient: case report and review of the literature.

BACKGROUND: Focal intracranial abscesses due to Salmonella spp are rarely reported. They tend to occur in patients who are immunosuppressed and in those with other predisposing factors. We present herein the first reported case of Salmonella enteritidis brain abscess in a sickle cell disease (SCD) patient. METHODS: We describe the case of a 29-year-old black African female with SCD who presented to her local hospital with a left frontal abscess. She was treated with emergency burr hole aspiration of the abscess and antibiotics. The aspirate grew S. enteritidis PT 8 on culture. All investigations into the source of the infection proved negative. The patient made a full recovery. We also present a detailed review of S. enteritidis brain abscesses in the medical literature. RESULTS AND CONCLUSIONS: S. enteritidis brain abscesses are very rare and are usually associated with immunocompromised conditions. Our patient appears to be the first reported case associated with SCD, the pathogenesis of which is unclear at present. Further clinical research is suggested in countries with a high prevalence of SCD to determine the association of SCD and the development of Salmonella brain abscesses.

Mycobacterium chelonae lumbar spinal infection.

A case report of a previously healthy adult patient with a lumbar spinal extradural abscess due to Mycobacterium chelonae is presented. His course of treatment was complicated by recurrent psoas abscesses, as well as multiantibiotic resistance, requiring multiple surgical drainage procedures and antibiotic changes over a 33-month period. Cure was achieved only after aggressive surgical debridement of the abscess.

Arachnoid cyst of the craniocervical junction: case report.

OBJECTIVE AND IMPORTANCE: An arachnoid cyst at the craniocervical junction presenting with obstructive hydrocephalus as a result of blockage of the outflow of the fourth ventricle is described. This is a very rare anatomic site, with only five other cases described in the literature. CLINICAL PRESENTATION: A 37-year-old woman presented with a 9-month history of severe neck pain, persistent vomiting, visual disturbances, and numbness of the nose, cheek, and lips. She had severe bilateral papilledema on ophthalmoscopy. Magnetic resonance imaging revealed a midline cystic lesion extending down to C2. INTERVENTION: The patient underwent posterior fossa craniectomy and excision of the arachnoid cyst. She made a full recovery and was asymptomatic at follow-up examination. CONCLUSION: The symptomatology of these rare craniocervical arachnoid cysts and their development are discussed.

Microvascular reconstruction of complex craniofacial defects.

Many large vault or skull base tumours are best treated by wide surgical excision and primary reconstruction using a microvascular free tissue transfer (free flap). We report 23 patients who were reconstructed using free flaps, eight having been previously treated surgically elsewhere and seven of whom had recurrent disease after radiotherapy. There was one flap failure and a local recurrence rate of 16% (3/19). The outcome at a mean follow-up period of 29 months, was 19 patients alive and four deaths.

Bacterial intracranial aneurysms.

This is a retrospective study of 25 patients with bacterial intracranial aneurysms treated in a single department over a 20-year period. The clinical presentation, investigation and treatment of these patients is discussed. The outcome of the treatment is assessed and is thought to be not as poor as previously reported.

Peroperative vertebral arterial catheterization for proximal control in aneurysm surgery.

Peroperative balloon control of the proximal vessel can be used for a difficult basilar trunk aneurysm. A patient in whom this technique was used is presented and the exact radiological method is described.

Infantile subdural effusions. A case report.

A case of post-traumatic infantile subdural effusion is reported in which spontaneous resolution did not occur. The patient developed features of raised intracranial pressure 1 month after a head injury and required drainage of the persistent effusions followed by shunting of the hydrocephalus. The pathology and management of subdural effusions are discussed.