Undetected permanent dental inflammation as a possible trigger for brain abscesses? A retrospective analysis over the last 2 decades.

Autor: Olivier M; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany. maximilian_olivier@web.de., Kraus LM; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany., Brandenburg LS; Department of Oral and Maxillofacial Surgery, Medical Center-University of Freiburg, Freiburg, Germany., Andereggen L; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.; Faculty of Medicine, University of Bern, Bern, Switzerland., Fung C; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany., Beck J; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany., Schnell O; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany.; Department of Neurosurgery, Medical Center-University of Erlangen-Nürnberg, Erlangen, Germany., Cipriani D; Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany.; Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.; Faculty of Medicine, University of Bern, Bern, Switzerland.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Jul 31; Vol. 166 (1), pp. 313. Date of Electronic Publication: 2024 Jul 31.
DOI: 10.1007/s00701-024-06208-6
Abstrakt: Background: Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting.
Methods: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin.
Results: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal.
Conclusion: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: