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    Home > Active Ingredient News > Study of Nervous System > ​A 4-year-old child has 8 abscesses in the brain?

    ​A 4-year-old child has 8 abscesses in the brain?

    • Last Update: 2021-04-19
    • Source: Internet
    • Author: User
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    *The professional part involved in this article is only for medical professionals to read for reference.
    If a child has headache symptoms, parents should pay attention to it.

     Not long ago, there was a news report that "In the small head of a 4-year-old boy, Yang Yang, there are eight brain abscesses, the biggest being the size of an egg.

    " Seeing this news, the "jiemei" can be frightened.

    Why are there so many abscesses in the brain at a young age? What is this egg-sized abscess? Will it threaten the life of a child? I believe that many parents are as surprised as the "Jiemei", but in addition to being surprised, parents are bound to worry about whether this situation will happen to their children.

     "Jiemei" learned that the child was finally cured and discharged at Xinhua Hospital, Shanghai Jiaotong University School of Medicine.
    She was also fortunate to invite Director Chen Ruoping of the Extrapediatric Neurological Disease Diagnosis and Treatment Center who participated in this diagnosis and treatment to reveal this "strange" case for us.
    The truth behind the case!
    The first step to find the truth: restore the case history.
    The case at a glance The child, male, 4 years old.

    He was admitted to the hospital for "fever with dizziness and headache for 5 days".

    Before admission, the child developed fever without obvious incentives, up to 39°C, accompanied by chills, dizziness, and mild lethargy.

    Visited the local hospital twice.
    The outside hospital considered the diagnosis and treatment of acute upper respiratory tract infection and tonsil inflammation, and provided symptomatic treatment such as antipyretic and anti-inflammatory.
    Although the body temperature of the child improved after treatment, he was lethargic and the body temperature still fluctuated.

    The day before I entered Xinhua Hospital, I was sued in the morning for severe occipital pain, which became a continuous dull pain, which was unbearable.
    When I got a headache, I rolled on the bed.

    The local area was given an emergency head CT examination and considered it as a frequent intracranial space occupation, and asked to be transferred to a higher-level hospital.

    After admission, head MRI was performed to determine the nature of intracranial lesions.

    Due to the complexity of the condition, the hospital decided to form a multidisciplinary joint diagnosis and treatment team (the main experts are Chen Ruoping, Director of the Center for Extra-Pediatric Neurological Diseases, Huang Lisu, Director of the Infectious Diseases Department, and Chu Caiting, Director of the Imaging Department).
    After the consultation, it is more likely to be considered as a brain abscess.

     Figure 1.
    MRI showed multiple ring-shaped enhancement lesions in the brain.
    After repeated discussions, the joint diagnosis and treatment team developed a diagnosis and treatment plan for the child.
    According to the epidemiological evidence of brain abscess, anti-inflammatory treatment covering common pathogens was carried out.
    Perform precise abscess puncture and aspiration under navigation and positioning.

    The operation was very successful, the headache symptoms of the child were relieved, and the brain abscess "disappeared".

    However, two weeks later, several abscesses reappeared in the brain of the child with head MRI; after the second operation, the child recovered and was discharged from the hospital.

      The key to finding the truth: in-depth analysis of disease brain abscess, it seems that it is not particularly common.

    Director Chen Ruoping told us that with the gradual improvement of my country's living standards, the incidence of infectious diseases similar to brain abscesses is getting lower and lower.

    At present, there is no clear cause of brain abscess.
    The reason why it is common in children is that pathogens are more likely to invade children with relatively weak immune systems.

    The symptoms of this child were not obvious at the beginning, mainly symptoms similar to colds and fever, and later uncomfortable symptoms such as fatigue and headache [1].
    At this time, the parents may not pay attention to this situation, and the situation is serious.
    Later, I went to the hospital for treatment, and after examination, it was found that the brain abscess was "causing".

    In fact, 1-2 brain abscesses are more common, and multiple brain abscesses are generally rare.

    Director Chen Ruoping emphasized that although multiple brain abscesses are more "dangerous", in general, the number of brain abscesses has been determined when they occur, and it is not that they can grow longer in later stages.

    Director Chen Ruoping recalled that during the head MRI, they found that there were 8 abscesses in the brain of the child.
    In addition, the abscess in the brain had a high tension.
    The child already had headache symptoms and might rupture at any time, so it was necessary.
    Deal with it as soon as possible.

    However, this case involves two fields, both in neurology and infectious diseases.

    At the same time, experts are faced with two key problems: first, the abscess concentration ratio is very thick, and it is difficult to treat with antibiotics; second, the brain abscess has a space-occupying effect.
    As the disease progresses, the abscess wall may rupture.
    Cause the pus to spread out, which may directly lead to the death of the child.

    Therefore, they finally decided to set up a "multidisciplinary joint diagnosis and treatment team" to maximize the prognosis of the children through strong cooperation.

    How is it treated? Director Chen Ruoping said that the treatment of abscesses mainly consists of two parts: the neurosurgery doctor is responsible for removing the abscess and reducing the risk of space-occupying and rupture of the abscess; the infection doctor will carry out precise anti-inflammatory treatment, and strive to achieve The best treatment effect.

    After treatment, the child's condition has improved significantly.

    However, the thing that Director Chen Ruoping was worried about also happened: the abscess that had been aspirated intracranially in the child recovered well, but the deep abscess had grown up.

    So there was a situation where "head MRI showed several abscesses again"! The joint diagnosis and treatment team once again conducted a detailed analysis and discussion on the situation, and decided to perform a second operation on the child.

    However, Director Chen Ruoping told us that the second operation is more difficult, not only because the adhesions after the first operation increase the difficulty of the operation, but also to minimize the damage to the brain tissue during the operation to avoid the spread of infection.

    "Fortunately, the results of the pus culture after the second operation indicated that the bacteria in the pus had been basically killed, and antibiotic treatment had a significant effect.

    Follow-up of the child’s head MRI showed that the child’s abscess was more severe It’s getting smaller, and it’s even completely absorbed.

    This means that the child does not need to be  operated on again and only needs to continue to receive anti-inflammatory treatment.

    This year’s Spring Festival, the child’s follow-up results indicate that the disease is basically cured.

    Figure 2.
    MRI shows that the abscess is basically absorbed.
    Director Chen Ruoping told us , Even if the child’s brain abscess has been "cured", the child will still need to be reviewed regularly in the next 5 years to follow up his brain examination.

     The early symptoms of brain abscess are not obvious, what can parents do? Although brain abscess is not common, leaving it alone will pose a threat to the child's life and health! If the child has headache symptoms, parents should pay attention to it.
    It should not be simply considered that "headaches are caused by colds and fever".
    They should first take their children to a regular hospital for examination.

    In addition, Director Chen Ruoping emphasized that children should not squeeze acne and blackheads on the face with their hands, especially the triangle area.
    These operations can easily cause infections to go up, and then cause brain abscesses (there is no brain abscess caused by squeezing the blackheads on the nose before.
    Examples!) If a child is diagnosed with inflammatory diseases such as otitis media and rhinitis, parents need to pay special attention to the child’s condition.
    These inflammatory diseases may be complicated by brain abscesses; furthermore, let the child strengthen physical exercise and go outdoor activities to improve the body.
    Immunity is the "one rule" to reduce the risk of infection.

    Finally, in daily life, it is necessary to pay attention to a balanced diet and not to supplement the child with too much nutrition.

    If the nutritional supplement is excessive, it may cause the body's metabolic disorder, but it will reduce the child's immunity and give pathogens the chance to cause disease! References: [1] Huang Yuanjun, Cao Du, Duan Li, et al.
    Analysis of clinical manifestations and MRI features of brain abscesses[J].
    Frontiers in Medicine, 2019, 2019, 9(15)(15).
    Introduction of experts Ruoping Chen, Associate Professor/Director Chief Physician, Doctor of Surgery of Shanghai Jiaotong University School of Medicine, Master's tutor of Shanghai Jiaotong University School of Medicine, Director of Pediatric Surgery Neurological Diseases Center of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine; 31 years of experience in neurosurgery and pediatric neurosurgery, good at Minimally invasive surgery technology diagnoses and treats various pediatric neurosurgical diseases, especially difficult and complex diseases.

    Good at diagnosis and treatment of various types of tumors: tumors in functional areas of the cerebral hemisphere, medulloblastoma, ependymoma, three ventricle tumors, pineal region tumors, craniopharyngiomas, brain stem tumors, skull base tumors, spinal and spinal cord tumors; Good at diagnosis and treatment of various types of congenital malformations of the nervous system: hydrocephalus, myelomeningocele, tethered cord syndrome, subtonsillar hernia, craniosynostosis, various cranio-maxillofacial deformities.

    Good at treating various brain and spinal cord vascular malformations with neurointerventional techniques; good at stereotactic surgery techniques for the treatment of functional diseases such as epilepsy in children; good at intracranial pressure monitoring, intraoperative neuro-electrophysiological monitoring techniques and children's neurosurgery; presiding and serving as a sub-project The person in charge has completed 9 scientific research projects at all levels, including major projects from the National Natural Science Foundation of China.

    Published 20 papers, of which the SCI paper with the highest score reached 15.
    804 points; served as a member of the Pediatric Neurosurgery Professional Committee of the Chinese Medical Doctor Association, a member of the Pediatric Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association, a member of the Pediatric Surgery Group of the Shanghai Medical Association, Shanghai Member of the Pediatric Group of the Neurosurgery Branch of the Medical Association, and member of the Neuro-Tumor Professional Committee of the Shanghai Anti-Cancer Association.

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