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Authors:
Kané B, Dembélé G, Diallo K.W, Dama M, Coulibaly O, Camara M.A, Sissoko D, Touré B.M, Togo.B, Diallo B., Kané AST., Mali
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Abstract:
Introduction
Early diagnosis of congenital heart
disease has a positive impact on its development. Brain abscess is a serious,
late complication of cyanogenic congenital heart disease.
The authors report two cases of cerebral
abscess complicating a tetralogy of Fallot in a 5-year-old child and an
interventricular communication in an 11-year-old adolescent in the care of the
Mali Hospital.
Clinical cases
Observation
1:
He was a 5-year-old boy with a history of dyspnea, admitted with left
hemiplegia. A brain scan revealed multiple abscesses. Cardiac ultrasound
requested as part of the etiologic workup revealed a tetralogy of Fallot.
Surgical drainage associated with sodium valproate: 10 mg/Kgs/12 hours slowly
intravenous, ceftriaxone: 100 mg/Kgs/d once directly intravenous, metronidazol
injection: 10 mg/Kgs/12 hours slowly intravenous for 15 days, gentamicin: 3
mg/Kgs/d slowly intravenous once for 3 days and motor physiotherapy. Relay was
taken orally with ciprofloxacin, metronidazole for 1 month and sodium valproate
for 2 years. The postoperative follow-up was simple with a progressive
improvement of hemiplegia and persistence of hypoxia.
Observation
2:
The patient was an 11-year-old adolescent with a history of ventricular septal
defect, admitted with right hemiplegia. A brain scan showed multiple abscesses.
Surgical drainage including
ceftriaxone-sulbactam combination: 75 mg/Kgs/d in 2 direct intravenous
administrations, methyl prednisolone hemisuccinate 1mg/kg/d in 100 ml slow
intravenous saline over 1 hour for 7 days. On the 15th day of hospitalization
the abscess was operated. The operation was followed by an intracranial
hemorrhage. It was detected the same day in a hemorrhagic shock picture.
Conclusion
Brain abscess is a serious and late
complication of congenital heart disease in children. The brain scan essential
for diagnosis should be routinely requested in hemiplegia in children with
heart disease.
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