Brain Abscess in a Child. Case Report

Brain abscesses in children are rare, but can lead to severe complications, especially if they are not recognized and treated promptly.We present the clinical case of a four-year-old girl who was admitted in the Second pediatric clinic at St. Marina University hospital in Varna because of attacks of severe frontal headache, sometimes accompanied by vomiting. The child was first hospitalized at the Infectious disease clinic for a bacterial intestinal infection, but during the hospital stay the attacks became more frequent. After the child was discharged, the parents noticed that the movements of the left limbs were severely impaired, with the left leg being swayed during walking. At the Second pediatric clinic, the child was conscious, afebrile, with normal general exam, but with pronounced syndrome of meningeal irritation and with left hemiparesis. Blood tests showed evidence of bacterial infection. Computed tomography was performed, where a large cystic formation (70/50 mm) was visualized in the right cerebral hemisphere, corresponding to an abscess with severe dislocation, requiring surgery to be performed urgently. The child had a smooth post-operative period, with no evidence of infection and no seizures. The focal neurological signs regressed over the following few days. A repeat CT scan of the head showed complete evacuation of the abscess and reduction of the edema. The girl was discharged on the fifteenth day, in good overall condition, with no headaches, and with fully restored motor activity. We discuss the diagnosis, differential diagnosis, the role of timely imaging and the treatment applied for the good prognosis of the patient

Cortical laminar necrosis after subarachnoid hemorrhage

Кортикалната ламинарна некроза е рядко наблюдавана при пациент след емболизиране на мозъчна аневризма. Съобщаваме случай на 51-годишна пациентка, която след емболизация на мозъчната аневризма на дясната средна мозъчна артерия остава в коматозно състояние.От извършения ядрено-магнитен резонанс имаше висок интензитет на сигнала в темпоралния лоб на мозъка на T2- изображенията, и линеарен хиперинтензитет по протежение на мозъчните кората на T1-изображенията с дифузно усилване на мозъчната кора.Cortical laminar necrosis has rarely been observed in a patient after coil embolization. We report a 51-year-old female patient who became comatose after the embolization of an aneurysm in the right middle cerebral artery. There were high signal intensities in the temporal brain on T2-weighted MRI images and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement

Stereotactic neuronavigation-assisted evacuation of intracranial abscess localized in the thalamus. A case report

Introduction: A brain abscess is a localized focal area of intracerebral infection that develops into a collection of pus surrounded by a well vascularized capsule. It has a rare incidence of 2% of all space occupying lesions and the deep-seated thalamus as a location is reported in 1.3 to 6% of all brain abscesses. The use of stereotactic neuronavigation-guided surgical evacuation is a minimally invasive option for achieving good treatment results.Materials and Methods: A 67-year-old female with constant headache, vertigo, staggering and muscle weakness for the right leg developed memory problems and confusion few days prior to admission in the Department of Neurosurgery. Upon examination, raised intracranial pressure, right-sided spastic hemiparesis, and memory and cognitive disturbance were present. The laboratory results showed leukocytosis, elevated glucose, cholesterol and C-reactive protein levels. A computed tomography (CT) scan showed a circular ring-like lesion localized in the region of the left thalamus that enhanced its peripheral hyperdensity after contrast application. Neuronavigation-assisted surgical evacuation was executed. A biopsy needle was inserted in the left thalamic region and the evacuated sample was sent for pathological and microbiological examinations.Results: The lesion was verified as an abscess and antibiotic therapy was prescribed for 20 days based upon the isolated bacterium and its sensitivity.Conclusion: An abscess localized in the deep-seated region of the brain is a diagnostic and therapeutic challenge. Frameless neuronavigation-guided surgical procedure is an elegant option for minimally invasive approach that allows evacuation and additional examination for correct diagnosis and effective treatment

Intraoperative Ultrasound-Assisted Assessment of the Degree of Decompression in Lumbar Spinal Stenosis // Интраоперативна ултразвук-асистирана оценка на степента на декомпресия при лумбална спинална стеноза

Lumbar spinal stenosis is defined as a pathological narrowing of the vertebral canal and/or intervertebral foramens, leading to compression of the dural sac and/or nerve roots. The increasing narrowing of the spinal canal is caused by degenerative changes such as facet arthropathy, disc degeneration, spondylolisthesis, deformity/thickening of the yellow ligament, which compress the dural sac and nerve roots. The main clinical manifestations of lumbar spinal stenosis are neurogenic claudication and lumbar pain, and the presence of radicular symptoms passing to the lower extremities is often established. These complaints create a precondition for disability of patients, inability to perform most of their daily needs and deteriorating quality of life. In recent years, surgery has been established as a trend in the treatment of lumbar spinal stenosis. Spinal stenosis is the most common indication for surgical treatment in the lumbar region and reaches a high percentage among surgical interventions performed in adult patients (< 65 years). This makes spinal stenosis a socially significant disease and a common reason for surgical consultation. The indications for surgical intervention at this time are not standardized and are determined based on the clinical picture and data from imaging studies, which assess the degree of compression and target levels. The main goal of surgical treatment is to decompress the affected nerve structures. To a large extent, the operator's perception is leading when making an intraoperative assessment of decompression. This is an assumption for the introduction of various intraoperative methods, which should reproduce the existing and evidential data on the degree of decompression in lumbar spinal stenosis. There are editing intraoperative techniques that are associated with the use of C- or O-arm endoscope, intraoperative MR, as it can obtain information. Unfortunately, their use is associated with the high learning curve and special equipment that can be used in specialized centres. Diagnostic sonography or ultrasonography is an imaging technique based on the use of ultrasound. Intraoperative ultrasound is a device that is often used in neurosurgery. Sonography is a reliable method for intraoperative assessment, as it allows detailed differentiation of individual anatomical structures in the spinal canal. With the introducing of intraoperative ultrasound, it is possible to achieve an accurate, rapid and instantaneous assessment of the degree of decompression in lumbar spinal stenosis.Лумбалната спинална стеноза се дефинира като патологично стеснение на вертебралния канал и/ или интервертебралните форамени, което води до компресия на дуралния сак и/ или нервните коренчета. Нарастващото стеснение на спиналния канал се причинява от дегенеративни промени като фасетна артропатия, дискова дегенерация, спондилолистеза, деформация/ удебеляване на жълтата връзка, които оказват компресия на дуралния сак и нервните коренчета. Основните клинични прояви при лумбална спинална стеноза са неврогенно клаудикацио и лумбалгия, като често се установява и наличие на радикулерна симптоматика преминаваща по долните крайници. Тези оплаквания създават предпоставка за инвалидизация на пациентите, невъзможност за извършването на голяма част от всекидневните им действия и влошено качество на живот. През последните годините хирургичното лечение е утвърдено като тенденция при лечението на лумбална спинална стеноза. Спиналната стеноза е най-честата индикация за оперативно лечение в лумбален отдел, като също така достигна и висок процент сред хирургичните интервенции осъществени при възрастни пациенти (< 65г.). Това прави спиналната стеноза социално значимо заболяване и честа причина за консултация за оперативно лечение. Индикациите за провеждане на оперативна интервенция към този момент не са стандартизирани и се определят въз основа на клиничната картина и данните от образните изследвания, чрез които се оценява степента на компресия и таргетните нива. Основната цел на оперативното лечение е осъществяване на декомпресията на засегнатите нервни структури. До голяма степен усещането на оператора е водещо при поставяне на интраоперативна оценка за декомпресия. Това е предпоставка за въвеждането на различни интраоперативни методи, чрез които да се възпроизведат обективни и доказателствени данни за степента на декомпресия при лумбална спинална стеноза. Съществуват редица интраоперативни техники свързани с употребата на С- или О-рамо, ендоскоп, интраоперативен МР, чрез които може да получи търсената информация. За съжаление употребата им е свързана с висока крива на обучение и изисква специално оборудване, което могат да си позволят само високо специализирани центрове. Диагностичната сонография или ултрасонография е образна техника базирана на употребата на ултразвук. Интраоперативният ултразвук е устройство, което се използва често в неврохирургията. Сонографията може да бъде надежден метод за интраоперативна оценка, тъй като позволява детайлно разграничаване на отделните анатомични структури в гръбначномозъчния канал. Поради това е уместно да се установи дали чрез въвеждането на интраоперативен ултразвук е възможно достигането на точна, бърза и моментна оценка на степента на декомпресия при лумбална спинална стеноза