Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong

Abstract Objectives (1) To review the patient profile, management outcome and prognostic factors of brain abscess; (2) To compare the neurological outcome of nasopharyngeal carcinoma (NPC)-related brain abscess with non-NPC related brain abscess. Method Retrospective review of consecutive patients d...

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Veröffentlicht in:Clinical neurology and neurosurgery 2012-07, Vol.114 (6), p.560-563
Hauptverfasser: Tam, Mandy Ho-Man, Wong, George Kwok-Chu, Ip, Margaret, Kam, Michael Koon Ming, Abrigo, Jill Morales, Zhu, Xian Lun, Poon, Wai Sang
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container_end_page 563
container_issue 6
container_start_page 560
container_title Clinical neurology and neurosurgery
container_volume 114
creator Tam, Mandy Ho-Man
Wong, George Kwok-Chu
Ip, Margaret
Kam, Michael Koon Ming
Abrigo, Jill Morales
Zhu, Xian Lun
Poon, Wai Sang
description Abstract Objectives (1) To review the patient profile, management outcome and prognostic factors of brain abscess; (2) To compare the neurological outcome of nasopharyngeal carcinoma (NPC)-related brain abscess with non-NPC related brain abscess. Method Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period. Results Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08). Conclusion Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.
doi_str_mv 10.1016/j.clineuro.2011.11.028
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Method Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period. Results Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08). Conclusion Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2011.11.028</identifier><identifier>PMID: 22178290</identifier><identifier>CODEN: CNNSBV</identifier><language>eng</language><publisher>Amsterdam: Elsevier B.V</publisher><subject>Abscesses ; Adolescent ; Adult ; Aged ; Biological and medical sciences ; Brain ; Brain abscess ; Brain Abscess - etiology ; Brain Abscess - mortality ; Brain Abscess - radiotherapy ; C-reactive protein ; C-Reactive Protein - analysis ; Case Management ; Cell culture ; Central Nervous System Infections - etiology ; Central Nervous System Infections - therapy ; Child ; Child, Preschool ; Drainage ; Female ; Fever ; Follow-Up Studies ; Hong Kong - epidemiology ; Humans ; Infection ; Leukocyte Count ; Leukocytes ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Morbidity ; Mortality ; Nasopharyngeal carcinoma ; Nasopharyngeal Neoplasms - complications ; Nasopharyngeal Neoplasms - mortality ; Nasopharyngeal Neoplasms - radiotherapy ; Necrosis ; Nervous System Diseases - etiology ; Nervous System Diseases - psychology ; Neurology ; Neurosurgery ; Neurosurgical Procedures ; Peptostreptococcus ; Radiation necrosis ; Radiotherapy ; Radiotherapy - adverse effects ; Retrospective Studies ; Streptococcus ; Surgery (general aspects). 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Method Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period. Results Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08). Conclusion Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.</description><subject>Abscesses</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain</subject><subject>Brain abscess</subject><subject>Brain Abscess - etiology</subject><subject>Brain Abscess - mortality</subject><subject>Brain Abscess - radiotherapy</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - analysis</subject><subject>Case Management</subject><subject>Cell culture</subject><subject>Central Nervous System Infections - etiology</subject><subject>Central Nervous System Infections - therapy</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Drainage</subject><subject>Female</subject><subject>Fever</subject><subject>Follow-Up Studies</subject><subject>Hong Kong - epidemiology</subject><subject>Humans</subject><subject>Infection</subject><subject>Leukocyte Count</subject><subject>Leukocytes</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Nasopharyngeal carcinoma</subject><subject>Nasopharyngeal Neoplasms - complications</subject><subject>Nasopharyngeal Neoplasms - mortality</subject><subject>Nasopharyngeal Neoplasms - radiotherapy</subject><subject>Necrosis</subject><subject>Nervous System Diseases - etiology</subject><subject>Nervous System Diseases - psychology</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Neurosurgical Procedures</subject><subject>Peptostreptococcus</subject><subject>Radiation necrosis</subject><subject>Radiotherapy</subject><subject>Radiotherapy - adverse effects</subject><subject>Retrospective Studies</subject><subject>Streptococcus</subject><subject>Surgery (general aspects). 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Graft diseases</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tam, Mandy Ho-Man</creatorcontrib><creatorcontrib>Wong, George Kwok-Chu</creatorcontrib><creatorcontrib>Ip, Margaret</creatorcontrib><creatorcontrib>Kam, Michael Koon Ming</creatorcontrib><creatorcontrib>Abrigo, Jill Morales</creatorcontrib><creatorcontrib>Zhu, Xian Lun</creatorcontrib><creatorcontrib>Poon, Wai Sang</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical neurology and neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tam, Mandy Ho-Man</au><au>Wong, George Kwok-Chu</au><au>Ip, Margaret</au><au>Kam, Michael Koon Ming</au><au>Abrigo, Jill Morales</au><au>Zhu, Xian Lun</au><au>Poon, Wai Sang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong</atitle><jtitle>Clinical neurology and neurosurgery</jtitle><addtitle>Clin Neurol Neurosurg</addtitle><date>2012-07-01</date><risdate>2012</risdate><volume>114</volume><issue>6</issue><spage>560</spage><epage>563</epage><pages>560-563</pages><issn>0303-8467</issn><eissn>1872-6968</eissn><coden>CNNSBV</coden><abstract>Abstract Objectives (1) To review the patient profile, management outcome and prognostic factors of brain abscess; (2) To compare the neurological outcome of nasopharyngeal carcinoma (NPC)-related brain abscess with non-NPC related brain abscess. Method Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period. Results Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08). Conclusion Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.</abstract><cop>Amsterdam</cop><pub>Elsevier B.V</pub><pmid>22178290</pmid><doi>10.1016/j.clineuro.2011.11.028</doi><tpages>4</tpages></addata></record>
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subjects Abscesses
Adolescent
Adult
Aged
Biological and medical sciences
Brain
Brain abscess
Brain Abscess - etiology
Brain Abscess - mortality
Brain Abscess - radiotherapy
C-reactive protein
C-Reactive Protein - analysis
Case Management
Cell culture
Central Nervous System Infections - etiology
Central Nervous System Infections - therapy
Child
Child, Preschool
Drainage
Female
Fever
Follow-Up Studies
Hong Kong - epidemiology
Humans
Infection
Leukocyte Count
Leukocytes
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Morbidity
Mortality
Nasopharyngeal carcinoma
Nasopharyngeal Neoplasms - complications
Nasopharyngeal Neoplasms - mortality
Nasopharyngeal Neoplasms - radiotherapy
Necrosis
Nervous System Diseases - etiology
Nervous System Diseases - psychology
Neurology
Neurosurgery
Neurosurgical Procedures
Peptostreptococcus
Radiation necrosis
Radiotherapy
Radiotherapy - adverse effects
Retrospective Studies
Streptococcus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tomography, X-Ray Computed
Treatment Outcome
Young Adult
title Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong
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