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Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses
  1. Tsung-Han Lee1,
  2. Wen-Neng Chang2,
  3. Thung-Ming Su1,
  4. Hsueh-Wen Chang3,
  5. Chun-Chung Lui4,
  6. Jih-Tsun Ho1,
  7. Hung-Chen Wang1,
  8. Cheng-Hsien Lu2
  1. 1Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  2. 2Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  3. 3Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
  4. 4Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
  1. Correspondence to:
 Dr Cheng-Hsien Lu
 Department of Neurology, Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien 83301, Taiwan; chlu99{at}ms44.url.com.tw

Abstract

Background: Intraventricular rupture of brain abscesses (IVRBA) remains a catastrophic and fatal complication of bacterial brain abscess (BBA). However, no information has been reported about the risk factors that are predictive of intraventricular rupture.

Methods: This study was undertaken to determine the potential risk factors that are predictive of intraventricular ruptures in patients with BBA but without intraventricular rupture when arriving at the hospital. A comparison is also made between patients who already have IVRBA at the time of admission (initial IVRBA) and those who have the episode during hospitalisation (subsequent IVRBA).

Results: 62 patients, including 45 who had initial IVRBA and 17 who had subsequent IVRBA, were examined. Stepwise logistic regression analysis showed that the adjusted risk of intraventricular rupture during hospitalisation for patients with multiloculated brain abscesses had an odds ratio (OR) of 4.2 (95% confidence interval (CI) 1.24 to 14.3; p = 0.02) compared with those without multiloculated brain abscesses (referent); a reduction of 1 mm in the distance between the ventricle and brain abscesses would increase the rupture rate by 10% (p = 0.006, OR 0.9, 95% CI 0.83 to 0.97).

Conclusion: This study shows that if the abscess is deep seated, multiloculated and close to the ventricle wall, a reduction of 1 mm in the distance between the ventricle and brain abscesses will increase the rupture rate by 10%. Despite aggressive medical and surgical management shown in this series, many patients continue to progress poorly.

  • BBA, bacterial brain abscess
  • CGMH, Chang Gung Memorial Hospital
  • GCS, Glasgow Coma Score
  • GOS, Glasgow Outcome Score
  • IVRBA, intraventricular rupture of brain abscesses
  • MRI, magnetic resonance imaging

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Footnotes

  • Published Online First 29 September 2006

  • Competing interests: None declared.

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