Ahead of Print: Intracerebral Abscess with ICP Monitor
Background and Importance: Intracranial pressure (ICP) monitoring is a mainstay in the management of traumatic brain injury. Large investigations have validated the safety and efficacy of ICP monitors in comatose patients. Clinically relevant infections are extremely rare and cerebral abscess has never been reported using the Camino device. We describe an exceptional case of a life-threatening intracerebral abscess from an intraparenchymal ICP monitor.
Clinical Presentation: A 35 week old child required 7 days of ICP monitoring following a fall from a two-story window. His hospital course was complicated by severe airway edema treated, in part, with high dose corticosteroid therapy for a total of 10 days. Two weeks later the patient acutely deteriorated due to a large intracerebral abscess under the previous ICP monitor site. Urgent craniotomy with evacuation of the abscess was performed on two separate occasions. Cultures grew methicillin-sensitive Staphylococcus aureus which was treated with long-term antibiotics. At 3-month follow-up the patient was meeting age-appropriate milestones without focal deficits.
Conclusion: To our knowledge this is the first report describing an intracerebral abscess as a complication from an intraparenchymal pressure monitor. Corticosteroid therapy may have constituted an independent risk factor for the ICP monitor-associated infection, as well as re-insertion of the ICP monitoring device using the same site. That this is the first reported parenchymal infectious complication underscores the safety of this device with respect to infection. When reinsertion of a parenchymal monitor is considered, a new site should be chosen.
From: Intracerebral Abscess Associated with the Camino(R) Intracranial Pressure Monitor: Case Report and Review of the Literature by Morton et al.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
