E.I. Usanov, A.P. Lyapin, T.G. Toporuk, A.V. Drofa
(Filatov Children’s Municipal Hospital N 5, Saint Petersburg)
Male patient E., aged 8, was admitted to the Children’s Infectious Diseases Hospital on January 8, 2003. He was transferred from the Research Institute of Children’s Infections in a severe state and with complaints of headaches, flaccidity, drowsiness, nausea and vomiting. The disease started with a rise of temperature up to 37oC, observed on December 21, 2002. Then there was a subfebrile condition against a background of daily vomiting and continuous drowsiness. Neurological examination was indicative of anisocoria (S>D), a reduced response to light on the left, paresis of the left abducent and facial nerves, diplopia at looking to the left, reduced muscular tension, predominance of deep reflexes in extremities on the right, bilateral Babinski’s sign, positive Kernig’s sign, rigidity of occipital muscles.
CT examination, carried out on January 8, 2003, demonstrated two abscesses of the brain: one in the right and one in the left frontal lobes. Their size was 48 and 58 mm respectively. They had density of 20-23 H units and were surrounded by a capsule, accumulating a contrast substance. There was displacement of the anterior segment of the interhemispheric fissure to the right up to 7 mm. The third and lateral ventricles were dislocated backwards and to the left up to 4 mm. There was marked perifocal edema.
The operation was performed on January 9, 2003. Bilateral osteoplastic trephination of the skull, total removal of abscesses of the right temporal and left frontal lobes with a capsule were made. Subsequent through drainage of postoperative cerebral wounds was carried out during 5 days. Bacteriologic examination of abscess content revealed Staphylococcus aureus. Postoperative CT examination revealed epidural hematoma in the left frontal lobe within a trephination area (7´1.8 cm). There was no treatment of hematoma. It was conditioned by absence of clinical manifestations and presence of accompanying pathology. Neurological symptoms regressed.
The demonstration goal was to show possibility of one-stage removal of two brain abscesses and to present tactics of surgical treatment of multiple brain abscesses in the child with congenital M hemoglobulinopathy.