Zia Ullah, Ziaur Rehman.
Brain abscess in children with Cyanotic Congenital Heart Disease- clinical presentation and outcome.
J Saidu Med Col Jan ;7(2):107-11.

BACKGROUND: Brain abscess is a serious life threatening infection of brain parenchyma. Cyanotic congenital hearth disease is important predisposing factor for brain abscess. OBJECTIVE: This study was conducted to evaluate the clinical profile and outcome of children with brain abscess and underlying Cyanotic congenital hearth disease . MATERIALS & METHODS: The study was carried out at The Department of Paediatric Cardiology, Hayatabad Medical Complex, Peshawar. This study was conducted from June 2015 to May 2016. All children presenting with brain abscess and having an underlying Cyanotic congenital hearth disease were prospectively entered into this study. Data was collected on a written Performa and later on shifted to and analysed by SSPS 18 program. RESULTS: Thirty children with underlying Cyanotic congenital hearth disease were confirmed to have a brain abscess during this period. There were 22 (73%) males and 8 (27%) females. Majority (22 pts-73%) were in the age group 6 to 10 years. Mean duration of illness related to the brain abscess at the time of presentation was 15.2+18.6 days. All patients had a variable degree of fever while headache (25 pts-83%), vomiting (19 pts-63%) and seizures (19 pts-63%) were other common presenting features. Tetralogy of Fallot was the commonest underlying Cyanotic congenital hearth disease present in 23 patients (76.6%). The abscesses were large and required surgical drainage in 21 (70%) children while 9 (30%) patients had small abscesses requiring medical management only. A positive pus aspirate culture was present in 11/21 (52%) with commonest organism being Staphylococcus aureus (3/11). Surgical intervention consisted of single or repeated needle aspiration through burr hole and excision of abscess was done in two patients. There were 5 deaths (16.7%) and all died of severe cerebral oedema and tentorial herniation. Unconsciousness, focal neurological signs, papilledema and Glasgow Coma Scale less than 8 at the time of presentation were associated with poor outcome (p < 0.05). Seven children (23%) had long-term sequelae like hemiparesis & seizures. CONCLUSION: Majority of children presented with fever and headache. Other presenting features included vomiting and seizures. Brain abscess in children with underlying cyanotic congenital heart disease carries a high mortality and morbidity despite surgical treatment. Presence of fever and headache in any such patient shall alert the physician about this possibility.

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