Medical Cure of a Brainstem Abscess and Serial Brairxtem Auditory Evoked Potent i a Is Huei-Shyong Wang Meng-Fai Kuo Song-Chei Huang Brainstem abscess is an extraordinarily rare occurrence-only 66 cases have been reported in the literature. It is classically considered as having a lethal course (Lichtenstein and Zeitlin 1936, Gaida and Minn 1939, Weickhardt and Watts 1944, Davidoff 1945, Richland 1952, Hulme 1961, Weickhardt and Davis 1964, Cambier and Gautier 1966, Rimalovski and Aronson 1968, Masson et al. 1970, Mazars et al. 1972, Morgan et al. 1973, Samson and Clark 1973, Robert et al. 1975, Kozik and Ozarzewska 1976, Nair 1977, Abe et al. 1979, Murphy et al. 1979, Harvey and Carlow 1980, Petit et al. 1983). Only 13 cases of long-term survival have been reported: 11 of these were treated surgically (Danzinger et al. 1974, van Gilder et ul. 1974, Messina et al. 1977, Russell and Shaw 1977, Dake et al. 1986, Kashiwagi el al. 1987, Nauta et al. 1987, Rossitch et al. 1988, Fujino et al. 1990), five of whom received computed tomography-guided sterotactic aspiration (Nauta et al. 1987, Rossitch et al. 1988, Fujino et al. 1990). Non-surgical resolution of brainstem abscess has been reported in only two cases (Vallee et al. 1980, Vaquero et ul. 1980), one of whom had complete recovery of neurological function (Vaquero et al. 1980). All the surgical survivors had functional deficits. We report our experience with a nine-year-old girl with tetralogy

of Fallot, whose brainstem abscess was cured with parenteral antibiotics alone. Case report This nine-year-old female patient was born on 7th June, 1981, with cyanotic congenital heart disease which was later diagnosed as tetralogy of Fallot. She was first admitted to hospital on 9th January, 1986, because she had had fever and headache for more than 10 days. She was f o u n d t o have motor aphasia and right-sided central-type facial palsy on physical examination. Cranial computed tomography (CT) revealed appearances consistent with two brain abscesses over the left frontal and temporal areas. After eight weeks of antibiotic therapy and two burr-hole aspirations, she was discharged on 10th March, 1986, with normal neurological status. She was lost to follow-up until 5th February, 1989, when she experienced four to five days of dizziness and one day of low-grade fever. She presented with right-sided ptosis, abducens palsy, and peripheral-type facial palsy and left hemiparesis. Brain C T showed a hypodense lesion with ring enhancement over the right, posterior aspect of the brainstern (Fig. 1A). Vancomycin and chloramphenicol were given parenterally. Haemoglobin was 181g/L; the white blood cell count was 13200/mm’, with 63 per cent segmented and 2 per cent band neutrophils; serum aspartate aminotransferase (AST) was 19U/L (normal

Medical cure of a brainstem abscess and serial brainstem auditory evoked potentials.

The brainstem abscess of a nine-year-old girl with tetralogy of Fallot was cured after six weeks of parenteral antibiotic therapy, without surgical in...
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