Cerebral syphilitic gumma misdiagnosed as brain abscess: A case report

BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.

Brain abscess from oral microbiota approached by metagenomic next-generation sequencing: A case report and review of literature

BACKGROUND Brain abscess is a serious and potentially fatal disease caused primarily by microbial infection.Although progress has been made in the diagnosis and treatment of brain abscesses,the diagnostic timeliness of pathogens needs to be improved.CASE SUMMARY We report the case of a 54-year-old male with a brain abscess caused by oral bacteria.The patient recovered well after receiving a combination of metagenomic next-generation sequencing(mNGS)-assisted guided medication and surgery.CONCLUSION Therefore,mNGS may be widely applied to identify the pathogenic microor-ganisms of brain abscesses and guide precision medicine.

Brain abscess caused by Streptococcus anginosus group:Three case reports

BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.

Chemotherapy combined with bevacizumab for small cell lung cancer with brain metastases:A case report

BACKGROUND Small cell lung cancer(SCLC)is a common and aggressive subtype of lung cancer.It is characterized by rapid growth and a high mortality rate.Approximately 10%of patients with SCLC present with brain metastases at the time of diagnosis,which is associated with a median survival of 5 mo.This study aimed to summarize the effect of bevacizumab on the progression-free survival(PFS)and overall survival of patients with brain metastasis of SCLC.CASE SUMMARY A 62-year-old man was referred to our hospital in February 2023 because of dizziness and numbness of the right lower extremity without headache or fever for more than four weeks.The patient was diagnosed with limited-stage SCLC.He received 8 cycles of chemotherapy combined with maintenance bevacizumab therapy and achieved a PFS of over 7 mo.CONCLUSION The combination of bevacizumab and irinotecan effectively alleviated brain metastasis in SCLC and prolonged PFS.

Brain Abscess Surgery Outcome: A Comparison between Craniotomy with Membrane Excision versus Burr Hole Aspiration

Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases to verify the diagnosis because may even lead to death. CT scan with contrast is a good tool for diagnosing and localizing brain abscesses in late stages, however, it is difficult to diagnose them in the early stages. The development of MRI helps to more accurately diagnose brain abscess. Surgical management of brain abscesses is either medical or surgical through craniotomy or burr holes. Indications of each are still a point of debate among most neurosurgeons. Methodology: This is a descriptive longitudinal prospective study to compare the outcomes of two surgical procedures used in The National Centre for Neurological Sciences-Khartoum-Sudan (NCNS) from 2012 to 2015, craniotomy and excision of the abscess membrane versus burr hole and aspiration of brain abscess in terms of duration of hospitalization, length of antibiotic use, recurrence rate, number of images needed for follow-up, and the final postoperative early and late outcomes. The data was collected through a designed questionnaire and was then analyzed using SPSS version 20. No significant ethical approval was required for this study. Results: Fifty-four patients were operated on through craniotomy (29/54) and burr hole (25/54). Their ages ranged from 1 year to 53 years with an average presentation at 13 years of age. Most patients presented with fever (23.1%), convulsions (16%), vomiting (16.7%) and headache (15.4%). The mean of illness for both groups was almost 2 months. The majority of patients in this study were having no risk factors (38.9%) while the major risk factors seen were cardiac diseases (14.8%), neurosurgical procedures (13%) and otitis media (11.1%). As most patients presented late, the diagnosis of most was made using CT brain with contrast (83.3%). In most of the patients (85.2%) there were no organisms separated in the culture. 8/54 patients had positive cultures, 7/8 were bacterial and only one (1/8) was fungal. Most patients received antibiotics for 45 days postoperatively in both craniotomy and burr hole groups. When both groups were compared, those operated with craniotomy were found to have a relatively higher length of hospital stay, however, no significant difference was found between both groups. Also, it was found that those operated on with craniotomy had a high cure rate and less recurrence in comparison with burr hole group. Deterioration and death were significantly higher among craniotomy group. Only CT brain was used as the imaging modality of choice for follow-up in both groups for 4 months’ duration and it was noted that complete evacuation was significantly higher among craniotomy group while remnants were higher among burr hole group. Conclusion: Brain abscess is still a challenging condition for neurosurgeons in Sudan. The limited number of Sudanese neurosurgeons, neurosurgical centers and diagnostic facilities contributed to delay in diagnosing brain abscess in most patients. It is important to design a strict protocol and precautions for any neurosurgical operation or bedside procedure to prevent infection and subsequent brain abscess development. CT brain with contrast is a good imaging tool for assessing the size, site and stage of brain abscesses. No significant difference between craniotomy or burr hole for clearance from brain abscess in terms of antibiotic used or duration of hospital stay. However, burr hole aspiration is associated with higher rates of recurrences. On the other hand, craniotomy and excision have relatively higher neurologic morbidity postoperative with expectantly higher post-operative hospitalization but no differences in the final outcome. Therefore, the selection of surgical technique should be individualized in each case based on the abscess site size source patient fitness for surgery and neurosurgeon’s preference.

Isolated cerebral mucormycosis that looks like stroke and brain abscess:A case report and review of the literature

BACKGROUND Cerebral mucormycosis is an infectious disease of the brain caused by fungi of the order Mucorales.These infections are rarely encountered in clinical practice and are often misdiagnosed as cerebral infarction or brain abscess.Increased mortality due to cerebral mucormycosis is closely related to delayed diagnosis and treatment,both of which present unique challenges for clinicians.CASE SUMMARY Cerebral mucormycosis is generally secondary to sinus disease or other disseminated disease.However,in this retrospective study,we report and analyze a case of isolated cerebral mucormycosis.CONCLUSION The constellation of symptoms including headaches,fever,hemiplegia,and changes in mental status taken together with clinical findings of cerebral infarction and brain abscess should raise the possibility of a brain fungal infection.Early diagnosis and prompt initiation of antifungal therapy along with surgery can improve patient survival.

Brain Abscess after COVID-19: Case Report

As the COVID-19 pandemic progresses, complications and unusual presentations of the disease have been described. Among them, the involvement of distinct parts of the neuroaxis. We report a rare case of brain abscess in elderly after SARS-Cov-2 infection readmitted in our health unit. Patient was treated with ceftriaxone, metronidazole and vancomycin with good clinical and therapeutic response. The satisfactory conduct of the case was only possible by the involvement of a multiprofessional team, which sought early diagnosis, surgical intervention and adequate duration of treatment.

Inetetamab combined with pyrotinib and chemotherapy in the treatment of breast cancer brain metastasis: A case report

BACKGROUND Breast cancer brain metastasis(BCBM)is an advanced breast disease that is difficult to treat and is associated with a high risk of death.Patient prognosis is usually poor,with reduced quality of life.In this context,we report the case of a patient with HER-2-positive BCBM treated with a macromolecular mAb(ine-tetamab)combined with a small molecule tyrosine kinase inhibitor(TKI).CASE SUMMARY The patient was a 58-year-old woman with a 12-year history of type 2 diabetes.She was compliant with regular insulin treatment and had good blood glucose control.The patient was diagnosed with invasive carcinoma of the right breast(T3N1M0 stage IIIa,HER2-positive type)through aspiration biopsy of the ipsilateral breast due to the discovery of a breast tumor in February 2019.Immunohistochemistry showed ER(-),PR(-),HER-2(3+),and Ki-67(55-60%+).Preoperative neoadjuvant chemotherapy,i.e.,the AC-TH regimen(epirubicin,cyclophosphamide,docetaxel-paclitaxel,and trastuzumab),was administered for 8 cycles.She underwent modified radical mastectomy of the right breast in November 2019 and received tocilizumab targeted therapy for 1 year.Brain metastasis was found 9 mo after surgery.She underwent brain metastasectomy in August 2020.Immunohistochemistry showed ER(-)and PR.(-),HER-2(3+),and Ki-67(10-20%+).In November 2020,the patient experienced headache symptoms.After an examination,tumor recurrence in the original surgical region of the brain was observed,and the patient was treated with inetetamab,pyrotinib,and capecitabine.Whole-brain radiotherapy was recommended.The patient and her family refused radiotherapy for personal reasons.In September 2021,a routine examination revealed that the brain tumor was considerably larger.The original systemic treatment was continued and combined with intensity-modulated radiation therapy for brain metastases,followed by regular hospitalization and routine examinations.The patient’s condition is generally stable,and she has a relatively high quality of life.This case report demonstrates that in patients with BCBM and resistance to trastuzumab,inetetamab combined with pyrotinib and chemotherapy can prolong survival.CONCLUSION Inetetamab combined with small molecule TKI drugs,chemotherapy and radiation may be an effective regimen for maintaining stable disease in patients with BCBM.

SMALL BRAIN ABSCESS IN CHILDREN

A retrospective evaluation of 42 cases of podiatric brain abscess from 1985 to 1994 was performed. All patients were diagnosed by characteristic contrast-enhancement on CT scan.39 cases did not give a history of infection. The maximum diameter of the enhancement area was 2. 2cm Epileptic seizures were usually the initial and main symptoms,but local neurological signs werr absent.All of the cases were treated by antibiotic therapy.The duration of the therapy in most childhood patients was 2￣3 months,3 were over 3 months. They were followed up 1￣7 years after acute illness.Neurological sequelae were diagnosed in 3 of 42 cases.

Brainstem abscesses caused by Listeria monocytogenes:A case report

BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocytogenes in apreviously healthy adult patient. The patient’s magnetic resonance imagingexamination showed multiple brain abscesses, and his second cerebrospinal fluidculture test indicated the presence of Listeria monocytogenes. Despite earlyempirical therapy, the patient’s condition progressively deteriorated. Because thepatient's abscesses were located in the brainstem and multiple lobes, surgery wasnot possible. The patient died 40 d after admission.CONCLUSIONThis case highlights the importance of rational clinical use of drugs to avoidpotentially serious infectious complications.

Genome-wide interrogation of transfer RNA-derived small RNAs in a mouse model of traumatic brain injury

Transfer RNA(t RNA)-derived small RNAs(ts RNAs) are a recently established family of regulatory small non-coding RNAs that modulate diverse biological processes. Growing evidence indicates that ts RNAs are involved in neurological disorders and play a role in the pathogenesis of neurodegenerative disease. However, whether ts RNAs are involved in traumatic brain injury-induced secondary injury remains poorly understood. In this study, a mouse controlled cortical impact model of traumatic brain injury was established, and integrated ts RNA and messenger RNA(m RNA) transcriptome sequencing were used. The results revealed that 103 ts RNAs were differentially expressed in the mouse model of traumatic brain injury at 72 hours, of which 56 ts RNAs were upregulated and 47 ts RNAs were downregulated. Based on micro RNA-like seed matching and Pearson correlation analysis, 57 differentially expressed ts RNA-m RNA interaction pairs were identified, including 29 ts RNAs and 26 m RNAs. Moreover, Gene Ontology annotation of target genes revealed that the significantly enriched terms were primarily associated with inflammation and synaptic function. Collectively, our findings suggest that ts RNAs may be associated with traumatic brain injury-induced secondary brain injury, and are thus a potential therapeutic target for traumatic brain injury. The study was approved by the Beijing Neurosurgical Institute Animal Care and Use Committee(approval No. 20190411) on April 11, 2019.

Whole brain radiotherapy concomitant or sequential Vm26/DDP in treating small cell lung cancer patients with brain metastases

Objective： The aim of the study was to compare efficacies and safeties of 2 different treatments of whole brain radiotherapy （WBRT） sequential or concomitant Vm26/DDP for small cell lung cancer （SCLC） patients with brain metastases. Methods： A total of 39 patients were randomly divided into sequential chemoradiotherapy regime （A group, 20 patients） and concomitant chemoradiotherapy regime （B group, 19 patients）. The close of WBRT was 36 Gy in 18-20 fractions, chemotherapy of Vm26/DDP regimen with teniposide 60 mg/m^2 on dl to d3 and cisplatin 20 mg/m^2 on dl to d5, repeating every 3 weeks. The response was evaluated after WBRT and 2 cycles of chemotherapy. Results： Total response rates of A and B groups were 70.0% and 78.9% respectively （P = 0.520）. The median survival was 11 months in A group and 10 months in B group. Six, twelve and eighteen months cumulative survival rates of A and B groups were 75.0%, 42.5%, 26.2%, and 81.6%, 26.4%, 10.5%, respectively （χ^2 = 0.383, P 〉 0.05）. Response rate and the number of brain metastases were independent prognostic factors. Conclusion： Both sequential and concomitant chemoradiotherapy groups are effective, and the main toxicity with myelosuppression is tolerable after therapy. It can be applied firstly and effectively to the SCLC patients with brain metastases in clinic.

Recursive Partitioning Analysis Classification and Graded Prognostic Assessment for Non-Small Cell Lung Cancer Patients with Brain Metastasis:A Retrospective Cohort Study

Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients with brain metastasis （BM）.Methods：From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors （TKIs） in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox＇s regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models （RPA and GPA） were validated respectively.Results：All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval （95% CI） was 14 （12.3-15.8） months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different （P0.001）.In the multivariate analysis as RPA and GPA entered Cox＇s regression model,Karnofsky performance status （KPS） ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion：KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.

Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot

We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.

Rare case of cryptogenic brain abscess caused by Raoultella ornithinolityca

Cerebral abscess is a potentially fatal neurosurgical condition,despite improvements in technology,new antimicrobial agents and modern neurosurgical instruments and techniques.I report the case of a 64-yearold woman,affected by a right frontobasal brain abscess,compressing the homolateral frontal horn of lateral ventricle,with a second mass partially occupying the right orbital cavity.She presented also with inflammatory sinusopathy involving the right maxillary,ethmoid and frontal sinuses.After 14 d of clinical observation and antimicrobial therapy,the patient received a computed tomography scan,which showed growth of the cerebral mass,with a ring of peripheral contrast enhancement and surrounding edema.She promptly underwent neurosurgical treatment and recovered well,except for the sight in her right eye,which remained compromised,as before the operation.This is believed to be the first case of cryptogenic cerebral abscess caused by Raoultella ornithinolityca isolated from the brain,with more than 1-year follow-up.

Surgery Versus Stereotactic Radiosurgery for Single Synchronous Brain Metastasis from Non-Small Cell Lung Cancer

Objective： The aim of this study is to compare the effectiveness of surgery with stereotactic radiosurgery （SRS） for patients with a single synchronous brain metastasis from successfully treated non-small cell lung cancer. Methods： Between 1995 and 2002, 53 patients underwent resection of both primary non-small cell lung cancer and the associated single brain metastasis. There were 33 men and 20 women with a mean age of 57 years （range, 32-85 years）. At the time of diagnosis, 42 patients experienced lung cancer related symptoms, whereas 11 patients experienced brain metastases-related symptoms. 42 patients had received thoracic surgery first, and 11 patients had undergone neurosurgery or radiosurgery first. Pneumonectomy was performed in 9 out of 42 patients （21.4%）, lobectomies in 30 （71.4%）, and wedge resection in 3 （7.2%）. 48 patients （90.5%） underwent complete lymphadenectomy. 35 patients underwent brain metastasectomy. 18 underwent SRS. Results： There was no postoperative mortality and severe complications after either lung or brain surgery. Histology showed 34 adenocarcinomas, 16 squamous cell carcinomas, and 3 large cell lung cancers. 15 patients （28.3%） had no evidence of lymph node metastases （No）, 20 patients （37.7%） had hilar metastases （N1）, and 18 patients （34%） had mediastinal metastases （N2）. The 1-, 2-, 3- and 5-year overall survival rates were 49%, 19%, 10%, and 5%, respectively. The corresponding data for neurosurgery group were 55%, 17%, 11%, and 6%, respectively. The median survival time was 13 months. For SRS group the corresponding data were 44.8%, 20.9% 10.5%, and 2%, respectively. The median survival time was 14 months. The differences between the two groups were not significant （P〉0.05）. In lymph node negative patients （No）, the overall 5-year survival rate was 10%, as compared with a 1% survival rate in patients with lymph node metastases （N1-2）. The difference was significant （P〈0,01）. For adenocarcinomas, the 5-year survival rate was 5%. The correspondent data for squamous cell lung cancers was 3%. The difference was not significant （P〉0.05）. Conclusion： Although the overall survival rate for patients who have brain metastases from NSCLC is poor, surgical resection or radiosurgery may be beneficial in a select group of patients with synchronous brain metastases and lung cancer without lymph node metastases.

Is There Any Indication for Prophylactic Brain Irradiation in the Management of Small Cell Prostate Cancer?

Small cell prostate carcinoma (SCPC) is an extremely rare pathology with an aggressive behavior, characterized by early brain metastases. We describe three cases of SCPC where brain metastases occurred despite response to chemotherapy. The benefit of prophylactic brain irradiation (PBI), as part of the management of SCPC, is discussed and compared to its indications in small cell lung cancer.

Clinical and Radiological Features in the Cases with Cryptogenic Brain Abscess in Association with Patent Foramen Ovale: A Case Report and Review of the Literature

Brain abscesses are commonly associated with cranial trauma, a contiguous focus of infection, or hematogenous spread from a distant focus. However, no predisposing factors are identified in approximately 4% of the cases, being recognized as a cryptogenic brain abscess (CBA). Here we report a patient with a CBA in the left occipital lobe presumably caused by a periodontal disease. The patient displayed a patent foramen ovale (PFO), through which a spontaneous right-to-left shunt was revealed with transesophageal echocardiography. A literature review indicated that in contrast to cases of general brain abscesses, patients with CBA were older and mostly had dental disorders represented by periodontal diseases and a large PFO. In these patients, the abscess was located predominantly in the posterior circulation area, and their prognosis was worse than that of general cases. Consequently, we emphasize the significance of screening for PFO in cases of advanced age with CBA in the posterior circulation region. Furthermore, to avoid neurological sequelae, we suggest immediate surgical drainage with antibiotic administration and maintenance of oral hygiene.

Small Molecule-Assisted PET: Approaches to Imaging of Conformational Diseases of the Brain

PET (positron emission tomography) in vivo imaging of cerebral conformational diseases is essentially based on non-peptide small molecule ligands used to detect early alterations in peptide secondary structures and subsequent accumulation of aberrant oligomers and protein deposits involved in progressive neurodegeneration, cognitive and movement disorders. In this article, an overview is given about tracers currently available and lead structures of potential PET probes for detection of?β-amyloid (Aβ), tau protein, α-synuclein, constitutive (PrPc) and infectious isoforms (PrPsc) of prions (proteinaceous infectious particles) as imaging targets. Whereas the styrylpyridine derivative florbetapir, approved for clinical applications, the stilbene derivative florbetaben and the benzoxazole derivative BF227 show high affinity binding to Aβ, preclinical investigations promise improved pharmacokinetics for benzoimidazothiazoles, aryloxazoles and benzofuran derivatives. Tau protein imaging based clinically, presently, on the pyridine-pyridoindole T807 has got new incentives following identification of a series of pyrrolopyridine quinolines and pharmacokinetic improvements of fluoropropoxy quinolines including for instance THK-5351. The pyridine isoquinoline MK6240 is involved now in clinical trials. Most forward-looking efforts apply to small molecule ligands of α-synuclein, which are expected to permit a breakthrough in differential diagnostics of Parkinson-related dementia and Lewy body diseases. However, at the moment the proposed lead structures are in affinity and blood brain barrier delivery properties below the possibilities of Aβ?and tau protein ligands. This is the case also for potential tracers of prion proteins.

Perioperative Nursing of a Case of Right Temporal Lobe Brain Abscess Ruptured into the Ventricle

Objective: To explore the perioperative nursing method of brain abscess breaking into the ventricle. Methods: By reviewing the clinical data of 1 case of right temporal lobe brain abscess into the ventricle, the effective nursing methods were summarized. Results: The patient’s condition was advanced quickly, and the diagnosis was treated in time to avoid brain hernia, but the treatment was difficult because of the critical condition. Conclusion: Brain abscess is a very serious intracranial infectious disease. It is of great significance to observe the changes in patients’ condition and take effective nursing measures.