Management of brain stem abscess

The brain stem is an uncommon site of a brain abscess. Such lesions were in variably fatal before 1974, when the arrival of computed tomography and mag netic resonance imaging improved the prognosis. This new case with a good r esult shows the usefulness of early diagnosis, careful clinical and radiolo gical monitoring and combined medical and surgical management. A child 2 1/ 2 years of age was admitted to the department of neurosurgery for diagnosis and treatment of a brain stem lesion. The clinical context and discovery o f an intrabronchial foreign body, as well as neuroradiological investigatio ns, suggested a diagnosis of brain stem abscess. Initial treatment with bro ad spectrum antibiotics with good cerebral penetration was associated with an increase in the size of the abscess and clinical worsening. Stereotactic aspiration of lesion was performed by a transpeduncular approach under CT guidance and general anaesthesia. Secondary thoracotomy enabled removal of an intrabronchial needle. After evacuation, in spite of failure to identify the organism, neurological deficit resolved rapidly and the lesion no long er appeared on CT. Management of a brain abscess always includes antibiotic s. They must cover the organisms most often encountered in brain abscesses and have good cerebral penetration. Medical treatment seems to suffice for small abscesses. A brain stem abscess with rapid clinical signs, together w ith current neuroradiogical diagnostic techniques, enables early discovery of such abscesses when they are still small. Treatment of brain stem absces ses includes primary antibiotic therapy, then stereotaxic drainage when the re is any diagnostic doubt, poor clinical tolerability or antibiotic resist ance.