Department of Child Health, Faculty of Medicine, University of Indonesia Cipto Mangunkusumo Hospital, Jakarta

KONIKA Surabaya , 6-9 July 2008

Brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized

capsuleIncidence of brain abscess in CHD is 5-18%

CMH 2001-2007: 9 patients, 4 of them with Tetralogy of Fallot

Symptoms Headache (+) and vomit (+) Weakness of the right extremities Involuntary movement and paresis

Physical examination Alert, cyanotic Funduscopy: papil edema (+)/(+) Right cranial nerves paresis VI and VII Ejection systolic murmur Right hemiparesis, increased

physiologic reflexes, clubbing finger

Laboratory examinations Polycythemia and leukocytosis

Brain abscess should be considered in children more than 2 years presenting neurological deficits with cyanotic congenital heart disease

Dwi Fachri, Jimmy Passat, Irawan Mangunatmadja

Treatment Cefotaxime, metronidazole, chloramphenicol for 8 weeks Steroid for 2 weeks Aspiration and antibiotic intralesion (gentamycin) Physiotherapy

The diameter of abscess was 4.5 x 5 cm) there were midline shift to the right and perifocal edema

Follow up after 2 weeks of surgery The diameter of abscess was reduced to 2.5x3.5 cm ( before 4.5x5 cm)

No midline shift to the right

Edema was reduced

CT Scan before surgery

Cardiomegaly Decreased vascular markings

Round elevated cardiac apex

Tetralogy of Fallot

Echocardiography Tetralogy of Fallot

Chest X-Ray

Diagnosis Soliter brain abscess Tetralogy of Fallot