Occipital pyogenic brain abscess

 

Top pictures CECT head of a middle aged male showing right occipital brain abscess.

Bottom picture is CECT head of same patient 11 days after excision of brain abscess.

 

A middle aged male underwent surgey Excision) for pyogenic right occipital brain abscess. Culture revealed staphylococcus. He was sent home 3 days after surgery, however he had to be readmitted because of worsening headache and left sided weakness. Operating surgeon thought that his symptoms were because of brain edema.

As patient had already paid 7,000 US dollars, the surgeon referred this patient to me since my hospital is public hospital, as patient could not afford to continue treatment at the place of operating surgeon. Patient had been given steroids for 5 days after first operation( for what reason?).

I reopened the craniotomy and excised the residual abscess after which patient became fine and he was discharged 5 days after 2nd surgery.

There are 4  pertinent questions-

1. The first excision was incomplete.

2. Steriods are harmful if given in patients having infections like pyogenic brain abscess.

3. Wrong interpretation of  postoperative CT head believing that it is only edema.

4. If patient has already paid huge money, the operating surgeon has to offer right treatment even if patient has no more money.

I think this should be applicable every where and public hospitals can not be used to refer patients who have morbidity and such complications.

 

Comments (2)Add Comment

Raises questions
written by Thomas S, April 05, 2014
Thank you for sharing this interesting case.

It raises a number of different question:

First a question regarding this particular case: When the patient was discharged after the first surgery - was he treated with antibiotics? Per oral?

I wonder how common the use of steroids is for brain abscesses among our colleagues?

You mention that the patient could not afford the second surgery. How is private hospitals in general usually handling complications or incomplete surgery - is it included in the fee of the first surgery or do the patients pay also for the second surgery?

Grateful for feedback from all colleagues! (Comment here or use Contact us at the bottom of the page).
brain abscess
written by sharmakchand, April 06, 2014
The fees should include treatment of complicatios but fact is that patients are left to fend themselves. For scennd surgery patient was being asked for more money.
He receaived intravenous antiobiotics during hospital stay but when he was discharged after first surgery he was put on oral antibiotics.
I have never used steroids in brain abscess of whatever etiology.
Very morbid patients from private hospitals in Delhi and surrounding areas are just left at emergency room of public hospitals, like mine.
In monthly meetings of neurosurgeons in Delhi I have appealed to all participants to avoid such practice.
I am ready to accept all difficult cases which can not be handled by other neurosurgeons, but referrals like this are nothing but cheating.

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