Brain abscess or cerebral abscess
Brain abscess or cerebral abscess is an abscess caused by an inflammation and the collection of infected material, either via a local scalp infection (otitis, dental abscesses, sinus inflammation, temporal mastitis, epidural abscess) or via distant infectious sources (lung, heart, kidney etc) within the brain tissue. The infection can also occur through a scalp fracture after a head trauma or via surgical procedures.
Brain abscess in children is usually found in children with congenital heart disease.
It can occur at any age, but mostly during the third decade of life.
Brain abscess or cerebral abscess - Symptoms
Symptoms of a brain abscess may be due to a combination of:
• Increased intracranial pressure due to a space-occupying lesion (headache, vomiting, confusion, coma)
• Infection (fever, fatigue, etc.), and
• Focal neurological brain tissue damage (hemiparesis, aphasia, etc.).
The most common symptoms presented are:
• difficulty speaking in conjunction with a rapidly deteriorating course of fever
Symptoms and findings depend to a large extent on the specific location of the abscess in the brain. An abscess in the cerebellum, for example, may cause further complaints as a result of brain stem compression and hydrocephalus.
An Objective Neurological Examination (ANE) may reveal neck stiffness and may in certain cases mistakenly indicate meningitis..
The famous trio:
• focal neurological findings
are highly suggestive of brain abscess.
Pathogenic microorganisms which may be responsible for causing cerebral abscesses are:
Bacterial abscesses of the de novo kind occur rarely (if ever) in the brain, and detection of the infectious outbreak may be difficult. There is almost always a primary cause elsewhere in the body that must be sought carefully, since failure to treat the primary cause will lead to relapse.
The location of the infectious outbreak may be indicated by the abscess location: middle ear infections produce abscesses in the middle and posterior cranium. A congenital heart disease with right to left shunts often leads to abscesses in the distribution of the middle cerebral artery. Infections of the frontal lobe and ethmoid sinuses result in abscesses of the frontal lobes. Fungi and parasites may also cause abscesses.
Fungi and parasites are specifically associated with immunosuppressed patients.
Diagnosis is done via CT and MRI scans with the use of intravenous contrast imaging.
Brain abscess or cerebral abscess - Treatment
Treatment for cerebral abscess includes:
• identifying the cause by performing a culture and then treating the cause (microbial or other) by the administration of intravenous antibiotics
• decompression of the brain with surgical drainage of the abscess and by identifying the cause by performing a culture