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    Brain Abscess

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    161220207

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    Brain Abscess

    Uploaded by

    161220207
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    Original Title

    11. Brain Abscess

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    3 views21 pages

    Brain Abscess

    Uploaded by

    161220207

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    © All Rights Reserved
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    of 21

    Brain Abscess

    Dr. Safdar Malik MD FCPS


    Definition
    Brain abscess is a focal suppurative infection within the brain parenchyma,

    typically surrounded by a vascularized capsule.

    Cerebritis: is often employed to describe a nonnencapsulated brain abscess.


    Brain Abscess
    Pathophysiology

    Risk Factors

    Signs & symptoms

    Evaluation

    Treatment

    10/8/23
    Epidemiology

    Relatively uncommon

    Incidence~.3-1.3:100000 person per year


    Etiology
    Brain abscess may develop by

    1. Direct spread from a contiguous cranial site of infection

    2. Head trauma, neurosurgical procedures

    3. Hematogenous spread

    25% cases : There isno primary source of infection


    Predisposing conditions
    Otitis media

    Mastoiditis

    Paranasal sinusitis

    Pyogenic infection of chest or any other part of body

    Penetrating head injury

    Neurosurgical procedure

    Dental infection
    Cont.
    In Immunocompetent persons:

    Streptococcus spp. (aerobic, Anaerobic and viridans) 40%

    Enterobacteriaceae (Proteus, E.coli, Klebsella) 25%

    Anaerobes (Bacteroides, Fusobacterium) 30%

    Staphylococci 10%

    Taenia solium(NCC)

    Mycobacterial infection (tuberculoma)


    Cont.
    In immuno-compromised host

    Nocardia

    T gondii

    Aspergillus

    Candida

    C. neoformans
    Stages
    1. Early Cerebritis: 1-3days

    A perivascular infiltration of inflammatory cells around a central core of coagulation necrosis

    2. Late Cerebritis: 4-9 days

    Pus formationin necrotic center which is surrounded by inflammatory cells and fibroblast

    3. Early Capsule Formation: 10-13 days

    A capsule that is better develop on corticalthen on ventricle side of lesion

    4. Late Capsule Formation: beyond 14 days

    A well defined necrotic center surrounded by a dense collageous capsule


    Clinical Presentation

    Typically presents as an expanding intracranial mass rather than as a infectious process

    Symptoms are gradual in onset

    Patients present in weeks to month

    Usually presents 11-12 days following onset of symptoms.


    Symptoms

    Classical triad: seen in <50% patients

    Headache 75%

    Fever 50%

    Focal neurologic deficit 15-35%


    Cont.
    Focal neurologic deficit
    Aphasia
    Hemiparesis
    Visual field defect
    Ataxia
    Nystagmus
    Seizures
    Raised ICP-Papilledema
    Meningismus Uncommon unless abscess rupture in ventricle
    Investigations
    TLC, DLC

    ESR, CRP

    Blood cultures

    Neuroimaging studies:

    MRI: better esp can detect early stages of cerebritis

    CT Scan: a focal area of hypodensity surrounded by ring

    enhancementwith surrounding edema (hypodensity)


    CT Scan

    10/8/23 14
    MRI

    10/8/23 15
    Microbiological Evaluation

    CT-guided stereotactic needle aspiration

    Gram’s Stain

    Culture : Aerobic, Anaerobic, Mycobacterial and fungal cultures

    Blood Culture

    LP: do not perform


    D/D
    Bacterial Meningitis

    Meningoencephalitis

    Acute disseminated encephalomyelitis

    Empyema

    Saggital Sinus Thrombosis

    Primary or Secondary brain tumor

    CVA
    Treatment
    Combination of high dose parentral antibiotics and neurosurgical drainage

    Third/fourth grneration cephalosporin+Metronidazole

    Patients with neurodurgery/Head trauma

    Vancomycin+Ceftazidine

    Meropenem+Vancomycin

    Modify antibiotics as per culture results

    Duration: Min 6-8 weeks


    Cont.
    Prophylactic anticonvulsant
    Should continue atleast 3 months after resolution of abscess

    Role of steroids
    Not given routinely
    Usually reserved for of significant periabscess edema with
    mass effect and raise ICP
    Dexamethasone 4 mg 6 hrly
    Cont.
    Aspiration and Drainage of the abscess under
    stereotactic guidance
    Craniotomy and Complete excision of a bacterial
    abscess: reserved for multiloculated abscess or in
    those where aspiration is unsucessful.
    Prognosis
    Mortality rate <15%
    Neurological sequelae ≥20% of survivors

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