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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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). Transplantations, organ and tissue grafts. Graft diseases ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult</subject><ispartof>Clinical neurology and neurosurgery, 2012-07, Vol.114 (6), p.560-563</ispartof><rights>Elsevier B.V.</rights><rights>2011 Elsevier B.V.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-20decb5e7d4333adca8f8f7ff2d07d8a6b1701a87fc76b2284a9f8dab30c8e303</citedby><cites>FETCH-LOGICAL-c514t-20decb5e7d4333adca8f8f7ff2d07d8a6b1701a87fc76b2284a9f8dab30c8e303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1036638973?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26030167$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22178290$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><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><title>Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><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.</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). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkl1rFTEQhoMo9lj9C2VBBG_2NB-7SfZGlENrpVUL6nXIJpOS427SJruF_vtmOadWeqMwJCE882Ym7yB0RPCaYMKPt2sz-ABzimuKCVmXwFQ-QysiBa15x-VztMIMs1o2XBygVzlvMcaMcfkSHVBKhKQdXqHLrzroKxghTFWcJxNHqKKrvl1u6gSDnsBWOtgqxFD_fdcn7UOl-2wg56ocz2K4qs7L8hq9cHrI8Ga_H6Jfpyc_N2f1xffPXzafLmrTkmaqKbZg-haEbRhj2hotnXTCOWqxsFLznghMtBTOCN5TKhvdOWl1z7CRUPo6RO93utcp3syQJzX6Us0w6ABxzopg1kjCWtL9B0oxbgnFC_r2CbqNcwqlkUWQcyY7wQrFd5RJMecETl0nP-p0VyC12KO26sEetdijShR7SuLRXn7uR7B_0h78KMC7PaCz0YNLOhifHzleLCVcFO7jjoPyxbceksrGQzBgfQIzKRv9v2v58ERiwXx59TfcQX7sW2WqsPqxDNMyS4SUMeqalt0D9b7D9Q</recordid><startdate>20120701</startdate><enddate>20120701</enddate><creator>Tam, Mandy Ho-Man</creator><creator>Wong, George Kwok-Chu</creator><creator>Ip, Margaret</creator><creator>Kam, Michael Koon Ming</creator><creator>Abrigo, Jill Morales</creator><creator>Zhu, Xian Lun</creator><creator>Poon, Wai Sang</creator><general>Elsevier B.V</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20120701</creationdate><title>Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong</title><author>Tam, Mandy Ho-Man ; Wong, George Kwok-Chu ; Ip, Margaret ; Kam, Michael Koon Ming ; Abrigo, Jill Morales ; Zhu, Xian Lun ; Poon, Wai Sang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c514t-20decb5e7d4333adca8f8f7ff2d07d8a6b1701a87fc76b2284a9f8dab30c8e303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Abscesses</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain</topic><topic>Brain abscess</topic><topic>Brain Abscess - etiology</topic><topic>Brain Abscess - mortality</topic><topic>Brain Abscess - radiotherapy</topic><topic>C-reactive protein</topic><topic>C-Reactive Protein - analysis</topic><topic>Case Management</topic><topic>Cell culture</topic><topic>Central Nervous System Infections - etiology</topic><topic>Central Nervous System Infections - therapy</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Drainage</topic><topic>Female</topic><topic>Fever</topic><topic>Follow-Up Studies</topic><topic>Hong Kong - epidemiology</topic><topic>Humans</topic><topic>Infection</topic><topic>Leukocyte Count</topic><topic>Leukocytes</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Nasopharyngeal carcinoma</topic><topic>Nasopharyngeal Neoplasms - complications</topic><topic>Nasopharyngeal Neoplasms - mortality</topic><topic>Nasopharyngeal Neoplasms - radiotherapy</topic><topic>Necrosis</topic><topic>Nervous System Diseases - etiology</topic><topic>Nervous System Diseases - psychology</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Neurosurgical Procedures</topic><topic>Peptostreptococcus</topic><topic>Radiation necrosis</topic><topic>Radiotherapy</topic><topic>Radiotherapy - adverse effects</topic><topic>Retrospective Studies</topic><topic>Streptococcus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. 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 & 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 & Medical Complete (Alumni)</collection><collection>Health & 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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