Clinical features, microbiology, and management of pediatric brainstem abscess

Abstract

Purpose: Brainstem abscess is a rare condition accounting for merely 1% of brain abscesses incidence in the pediatric population. This study aimed to present a single patient with a pontine abscess and review the literature to highlight clinical features, diagnosis, and management of brainstem abscess.

Methods: The PubMed database was screened for English-language articles concerning pediatric brainstem abscess. We, therefore, identified 22 publications, which concisely depict 23 cases. Our study reports on the 24th pediatric patient diagnosed with that entity. All included reports were analyzed in terms of clinical presentation, diagnosis, management, and outcomes of described patients.

Results: There was slight women predominance (15:9), with a mean age of occurrence 6.4 years, ranging from 7 months to 16 years. Pons was the most common location of brainstem abscess, occurring in 75% of patients. Clinically, they mostly presented with cranial nerves palsy (79.2%), hemiparesis (66.7%), and pyramidal signs (45.8%). The classic triad of symptoms, including fever, headache, and the focal neurologic deficit was present in 20.8% of patients. Positive pus cultures were obtained in 61.1%. Streptococci and Staphylococci were the most frequently identified pus microorganisms. Outcomes were satisfactory, with a 79.2% rate of general improvement.

Conclusions: Neurosurgical aspiration is a safe and beneficial therapeutic method. It should always be considered and should promptly be performed when the conservative treatment is not successful and clinical deterioration occurs. Prognosis in pediatric brainstem abscess is generally favorable. Most patients recover with minor neurologic deficits or improve completely.

Keywords: Brainstem abscess; Diagnosis; Management; Streptococcus intermedius.

Fig. 1

Axial cranial MRI a DWI, b T2-weighted, and c T1-weighted without gadolinium showing pontine abscess

Fig. 2

CT with contrast a axial and b sagittal reconstruction showing enlargement of the abscess (performed before biopsy)

Fig. 3

MRI performed 3 days after biopsy a horizontal with gadolinium, b frontal T2-weighted, and c sagittal T2-weighted showing reduction of abscess volume, but the enlargement of surrounding encephalitis area

Fig. 4

Axial cranial MRI a DWI, b T2-weighted, and c T1-weighted with gadolinium performed 1 month after admission showing nearly complete disappearance of the abscess