Tuberculous brain stem abscesses in children

Abstract

Tuberculous brain stem abscess is a highly uncommon entity. Three children with tuberculous brain stem abscesses of 1 month, 7 and 12 years of age were treated by microsurgical evacuation and biopsy of capsule, utilizing safe incisions over dorsal brain stem, through the floor of IV^th ventricle. There was no added deficit postoperatively in these children. Microsurgical evacuation and biopsy helped in differentiating these lesions from pyogenic abscesses in two cases for appropriate treatment. The third operated case was a child, who while being on antituberculosis treatment for proven tuberculous meningitis for 1.5 year developed medullary and pontine abscess and tuberculoma exemplifying a paradoxical response to chemotherapy. Brain stem abscess especially tuberculous need surgical drainage, as it provides an accurate proof of offending organism and also takes care of a paradoxical response to antituberculosis chemotherapy in diagnosed cases. The safe incisions on brain stem are helpful to avoid the morbidity. (J Pediatr Neurol 2004; 2(2): 101–106).

Keywords

brain stem abscess - tuberculosis