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Pediatric Brain Abscess
- Although rare, it is a serious life threatening entity of pediatric emergency medicine
- Must be in the differential of those with signs of increased intracranial pressure or focal deficit and hx of sinusitis, mastoiditis or cyanotic congenital heart disease.
- Investigation and diagnosis primarily with CT scan
- CSF studies demonstrate sterile fluid with elevated protein, and mildly elevated WBC
- Antibiotic coverage should be broad Naficillin/Vanc + Ceftriaxone + Metronidazole, until speciation and susceptibilities obtained from surgical specimen
- Steroids reserved only in cases of imminent herniation
- Controversy exists over prophylactic anticonvulsants
- Mortality recently <10% attributed to early diagnosis and appropriate antibiotic coverage.
References
Cochrane, D. "Consultation with the Specialist: Brain Abscess," Pediatrics in Review 1999 20: 209-215.
Red Book, American Academy of Peditrics Report of the Committee on Infectious Diseases