Manejo de un absceso cerebral por neuronavegación, a propósito de un caso clínico

Abstract

Brain abscess is a focal area of membrane necrosis that changes within the brain parenchyma, the result of an infectious or traumatic process. Its worldwide incidence is 8% of intracranial masses, with four cases per million. The most dangerous route of spread is hematogenous, and the most common pathogens involved are streptococci and staphylococci. Endocarditis allows the development of brain abscesses, with around 107 cases found in Ecuador, where patients present with headache, fever and focal neurological deficit. Drainage guided by stereotactic intervention definitively diagnoses it and successful management requires antibiotic therapy plus surgical drainage. A descriptive, analytical and retrospective investigation of an unusual case of brain abscess resolved by neuronavigation was carried out. Scientific databases such as Pubmed, Medline, New England, UpToDate, Cochrane, Springer-Link and the repositories of the Pontificia Universidad Católica del Ecuador and the Universidad Central del Ecuador for the last 5 years were used. Qualitative methodology studies and studies not accessible to the full text were excluded. We present the case of a 26-year-old male patient, with a history of ventricular septal defect and tricuspid atresia undergoing medical treatment, who presented with intense throbbing headache of 24 hours' duration, located in the right frontotemporal region and accompanied by nausea that did not reach the vomiting, plus fever of 38°C. Holosystolic murmur in the mesocardium on cardiac auscultation. On neurological examination, anisochoric pupils. Magnetic resonance imaging of the brain plus tractography and spectroscopy indicated a right frontal parenchymal occupying process in relation to a brain abscess, so it was decided to establish antibiotic therapy with Ceftriaxone, an anti cerebral edema scheme and analgesia. The transthoracic echocardiogram shows vegetations in the aortic ring, thus identifying the etiology. It was decided to escalate to broad-spectrum antibiotic therapy with Vancomycin along with drainage of the brain abscess by neuronavigation. Due to the limited use of new technologies for the treatment of brain abscesses, it was decided to report this case to better understand this technique and encourage its use in the medical community for similar cases