Intracranial suppurations surgically managed at Jos, North Central Nigeria: a nine-years retrospective review
Keywords:Suppurations, Intracranial, Craniotomy, North Central Nigeria
Background: Intracranial suppurations are rare but can be fatal entities consisting of pus collection within the intracranial cavity. The aim of the study was to document the clinical and radiological findings in our patients and the outcome of treatment.
Methods: A retrospective analysis of all consecutive patients presenting to the Jos University Teaching Hospital from January 2012 to December 2019. Data of interest were retrieved from their folders and entered into SPSS version 22 and descriptive statistics run on the variables.
Results: There were 33 patients within this period, but only 21 had complete records and thus used for the analysis. The median age was 18 years (IQR=29), males accounted for 81% of the patients. The median time to presentation was 14 days (IQR=23). The most common cause of abscess in our series was trauma (surgical and non-surgical) in 38.1%, followed by contiguous spread from the ear or paranasal sinuses (23.8%). The most common symptom was fever occurring in 61.9%, followed by headache 42.8%. In two thirds of the patients, the abscess was intra-axial (the frontal lobe being the most common site). Patients were managed surgically with either a craniotomy (28.6%) or a burr whole (71.4%). A positive culture was obtained in 33.3% of cases.
Conclusions: Intracranial suppurations are uncommon, but can occur in the setting of predisposing factors. A high index of suspicion is required to clinch the diagnosis.
Weinberg GA. Brain Abscess. Pediatr Rev. 2018;39(5):270-2.
Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806-13.
Klein RS, Garber C, Howard N. Infectious immunity in the central nervous system and brain function. Nat Immunol. 2017;18(2):132-41.
Brook I. Microbiology and treatment of brain abscess. J Clin Neurosci. 2017;38:8-12.
Schwerk C, Tenenbaum T, Kim KS, Schroten H. The choroid plexus-a multi-role player during infectious diseases of the CNS. Front Cell Neurosci. 2015;9:80.
Gadgil N, Chamoun RB, Gopinath SP. Intraventricular brain abscess. J Clin Neurosci. 2012;19(9):1314-6.
Singh Y, Gupta TK, Jaiswal G, Lodha K. Intracranial Abscesses: An Institutional Study. Open J Mod Neurosurg. 2020;10(2):297-306.
Chen M, Low DCY, Low SYY, Muzumdar D, Seow WT. Management of brain abscesses: where are we now?. Childs Nerv Syst. 2018;34(10):1871-80.
Bodilsen J, Brouwer MC, Nielsen H, Beek VDD. Anti-infective treatment of brain abscess. Expert Rev Anti Infect Ther. 2018;16(7):565-78.
Simjian T, Muskens IS, Lamba N, Yunusa I, Wong K, Veronneau R, et al. Dexamethasone Administration and Mortality in Patients with Brain Abscess: A Systematic Review and Meta-Analysis. World Neurosurg. 2018;115:257-63.
Osuntokun BO. The pattern of neurological illness in tropical Africa. Experience at Ibadan, Nigeria. J Neurol Sci. 1971;12(4):417-42.
Jimoh AO, Matthew M, Guga DA, Sale D, Giwa FJ, Aruna AA. Intracranial Abscesses in Ahmadu Bello University Teaching Hospital. AASCIT J Med. 2016;2(1):5-9.
Udoh D, Ibadin E, Udoh M. Intracranial abscesses: Retrospective analysis of 32 patients and review of literature. Asian J Neurosurg. 2016;11(4):384.
Anwary MA. Intracranial suppuration: Review of an 8-year experience at Umtata General Hospital and Nelson Mandela Academic Hospital, Eastern Cape, South Africa. S Afr Med J. 2015;105(7):584-8.
Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011;9(2):136-44.
Helweg LJ, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis. 2012;12:332.
Patel K, Clifford DB. Bacterial brain abscess. Neurohospitalist. 2014;4(4):196-204.
Olorunmoteni OE, Onyia CU, Elusiyan JBE, Ugowe OJ, Babalola TE, Samuel I. Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature. Childs Nerv Syst. 2020;36(8):1767-71.
Bodilsen J, Dalager PM, Beek VDD, Brouwer MC, Nielsen H. Risk Factors for Brain Abscess: A Nationwide, Population-Based, Nested Case-Control Study. Clin Infect Dis. 2020;71(4):1040-6.
Widdrington JD, Bond H, Schwab U, Price DA, Schmid ML, Carron B, et al. Pyogenic brain abscess and subdural empyema: presentation, management, and factors predicting outcome. Infection. 2018;46(6):785-792.
Sonneville R, Ruimy R, Benzonana N, Riffaud L, Carsin A, Tadie JM, et al. An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017;23(9):614-20.
Penna PA, Roos KL. Bacterial Infections of the Central Nervous System. Semin Neurol. 2019;39(3):334-42.
Khan IU, Latif A, Ashraf M, Chishti MK, Sadiq S. Outcome of management of brain abscess in children. Pak J Med Sci. 2020;36(3):306-9.
Kanu OO, Esezobor CI, Ojo OA, Asoegwu CN, Nnoli C, Dawang Y, et al. Infantile supratentorial subdural empyema managed by percutaneous aspiration: an outcome study in a Nigerian city. Sudan J Paediatr. 2019;19(1):37-43.
Zhai Y, Wei X, Chen R, Guo Z, Singh R, Zhang Y. Surgical outcome of encapsulated brain abscess in superficial non-eloquent area: A systematic review. Br J Neurosurg. 2016;30(1):29-34.