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Perifocal metabolism in a patient with brain abscess: insights from cerebral microdialysis
  1. Verena Rass1,
  2. Mario Kofler1,
  3. Alois J Schiefecker1,
  4. Max Gaasch1,
  5. Claudia Unterhofer2,
  6. Claudius Thomé2,
  7. Paul Rhomberg3,
  8. Bettina Pfausler1,
  9. Ronny Beer1,
  10. Erich Schmutzhard1,
  11. Raimund Helbok1
  1. 1 Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
  2. 2 Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
  3. 3 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
  1. Correspondence to Dr Raimund Helbok, Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria; raimund.helbok{at}tirol-kliniken.at

https://doi.org/10.1136/jnnp-2017-317652

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    Introduction

    Current management of bacterial brain abscess consists of parenteral antimicrobial therapy, abscess drainage and symptomatic treatment.1 Strict normoglycaemia is recommended in neurocritical care patients2; However, the optimal target for systemic glucose in patients with brain abscess is unknown.

    Cerebral microdialysis (CMD) allows the assessment of cerebral energy metabolism in patients with severe brain injury. Tight glycaemic control is known to be associated with a higher rate of metabolic distress, lower cerebral glucose levels and poor outcome in neurocritical care patients supporting the idea of a more liberal glucose regimen in these patients.3

    Here, we present a patient with bacterial brain abscess in whom CMD was used for brain metabolic monitoring in the perilesional area.

    Case presentation

    A 43-year-old previously healthy man presented with sudden onset of Broca’s aphasia and headache for 3 weeks. Neurological examination revealed a mild right facial palsy without other focal deficit. After admission, the patient developed a generalised tonic-clonic seizure. Anticonvulsive treatment with levetiracetam (1000 mg twice daily) was initiated. MRI showed a left frontotemporal lesion (maximum diameter 36 mm) with a ring-like contrast enhancement, diffusion restriction and prominent perilesional oedema suggestive of brain abscess (online Supplementary figure 1, panels A and B). Information on clinical presentation is given in the online Supplementary file 2. Stereotactic aspiration of the abscess and implantation of a CMD catheter (71 High Cut-Off, M Dialysis AB, Stockholm, Sweden; online Supplementary file 2) and brain tissue oxygen catheter (Licox Integra LifeSciences, Saint Priest, France) was performed on day 1 (first full calendar day) …

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