Summary
Nocardia brain abscess is a rare central nervous system (CNS) infection that carries a high mortality rate reaching 34% which is considered the highest amongst brain abscesses caused by microorganisms. All available literature is in the form of retrospective studies and small case series. In this case report the authors present a patient whose course of disease was stormy and required multiple neurosurgical procedures. The clinical outcome, long-term follow up and a review of the literature is discussed.
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This is a single case report of a patient with a cerebral Nocardia abscess complicated by ventriculitis. The infection was treated by antibiotics and aspiration of the abscess. Aggressive treatment of brain swelling and subsequent hydrocephalus lead to recovery. The report illustrates some of the hazards of this serious infection, occurring most often in immunocompromised patients, and the steps to successful treatment.
There is a good review of views about the place or timing of aspiration versus excision of abscesses.
The authors state that the patient in this report recovered with "moderate disability "according to the GOS. The details given of his state at 12 months surely place him in the "severe disability" category.
Peter Reilly
University of Adelaide
This is a detailed article on Nocardia brain abscess which covers the subject almost fully. However the primordial question that may be asked is, “Had the surgeon operated on the patient primarily and removed the abscess, without rupturing it, rather than aspirating it, would that have averted all the complications that ensued?” In fact the patient was later subjected to a more serious surgery while he was in a much more critical situation. The authors should be commended on their accurate discussion.
Professor Fuad S Haddad
American University of Beirut
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Zakaria, A., Elwatidy, S. & Elgamal, E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien) 150, 1097–1101 (2008). https://doi.org/10.1007/s00701-008-0026-2
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DOI: https://doi.org/10.1007/s00701-008-0026-2