[Brain abscess in children]. / Absceso cerebral infantil.

INTRODUCTION: Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003. METHODS: We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome. RESULTS: Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae. CONCLUSIONS: Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed.

Absceso cerebral infantil / Brain abscess in children

Introducción. El absceso cerebral es una infección poco frecuente en la infancia pero de una alta morbimortalidad que actualmente ha disminuido gracias al diagnóstico precoz debido a los avances en la imagen neurorradiológica y a las mejoras en la antibioterapia. Se describen 6 casos diagnosticados y seguidos en el Hospital Infantil Gregorio Marañón de Madrid desde enero de 1996 hasta septiembre de 2003. Métodos. Se analizan de forma retrospectiva las historias clínicas recogiéndose la edad, sexo, manifestaciones clínicas, exploración, estudio radiológico, etiología, tratamiento y evolución clínica de los mismos. Resultados. La edad de los pacientes se encuentra comprendida entre 8 y 15 años (media: 11 años); tres de ellos eran mujeres y 3 varones. Predominaron las manifestaciones neurológicas y cuatro de ellos tenían infección otorrinolaringológica asociada (sinusitis), uno cardiopatía cianógena y otro una meningitis. El diagnóstico se efectuó mediante tomografía computarizada (TC) en 5 casos y en uno mediante resonancia magnética (RM). La localización fue en 5 casos frontal y el tratamiento en todos ellos se realizó mediante antibioterapia de amplio espectro necesitando abordaje quirúrgico cinco de ellos. Dos pacientes tuvieron secuelas neurológicas. Conclusiones. Aunque el absceso cerebral es infrecuente hay que tenerlo en cuenta ante síntomas neurológicos asociados a la infección otorrinolaringológica o cardiopatía cianógena, debiéndose realizar una TC (o RM) y, tratándose con antibióticos de amplio espectro y en algunos casos drenaje quirúrgico

Introduction. Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003. Methods. We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome. Results. Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae. Conclusions. Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed