BRAIN ABSCESS
MOHD ROSLEE BIN ABD GHANI
LEARNING OBJECTIVES
• Define brain abscess
• State the causes of brain abscess
• State the signs and symptoms of brain abscess
• Describe the treatment of brain abscess
• State the complications of brain abscess
INTRODUCTION
• Brain abscess (or cerebral abscess) is define as a collection of pus enclosed in
the brain tissue, caused by a bacterial or fungal infection.
• Infectious sources;
1. local (ear infection, dental abscess, infection of paranasal sinuses, infection of the
mastoid air cells of the temporal bone, epidural abscess) or
2. remote (lung, heart, kidney etc.).
Introduction…
• The infection may also be introduced through a skull fracture following a
head trauma or surgical procedures.
• Brain abscess is usually associated with congenital heart disease in young
children.
• It may occur at any age but is most frequent in the third decade of life.
EPIDEMIOLOGY
• 0.3 -1.3 cases per 100,000 person
• Male : Female 2:1
• Median age 30-40 years
– Otitis focus : < 20 Yrs , >40 Yrs
– Paranasal sinus : 30 – 40 Yrs
• After cranial operation : 0.2 % of 1587 , 10 of 16540
• Commonly in Immunocompromised : infected with HIV, receiving
chemotherapy for cancer, receiving immunosuppressive therapy after organ
transplantation, or after prolonged use of corticosteroids.
CAUSES AND RISK FACTORS
• Nearly anyone can get a brain abscess, but certain groups of
people are at a higher risk than others.
• Some diseases, disorders, and conditions that raise your risk.
Causes and risk factors…
1. A compromised immune system due to HIV or AIDS
2. Cancer and other chronic illnesses
3. Congenital heart disease
4. Major head injury or skull fracture
Causes and risk factors…
5. Meningitis
6. Immunosuppressant drugs, such as those used in
chemotherapy
7. Chronic sinus or middle ear infections
PREDISPOSING CONDITION & LOCATION OF BRAIN ABSCESS
Otitis/mastoiditis Temporal lobe, Cerebellum
Frontal/ethmoid Frontal lobe
sinusitis
Sphenoidal sinusitis Frontal lobe,
Sella turcica
Dental infection Frontal > temporal lobe
Remote source Middle cerebral artery distribution (often
multiple)
SIGNS AND SYMPTOMS
• Symptoms may develop slowly, over a period of 2
weeks, or they may develop suddenly.
Signs and symptoms…
1. Changes in mental status
• Confusion
• Decreasing responsiveness
• Drowsiness
• Eventual coma
• Inattention
• Irritability
• Slow thought processes
Signs and symptoms…
2. Decreased movement
3. Decreased sensation
4. Decreased speech (aphasia)
5. Fever and chills
6. Headache
Signs and symptoms…
7. Language difficulties
8. Loss of coordination
9. Loss of muscle function, typically on one side
10. Seizures
11. Stiff neck
12. Vision changes
13. Vomiting
DIAGNOSIS
• History taking
• Physical examination
• A brain and nervous system (neurological) exam will usually show signs of
increased intracranial pressure and problems with brain function.
• Investigation
INVESTIGATIONS
1. Blood cultures
2. Chest x-ray
3. Complete blood count (CBC)
4. CT scan
5. Electroencephalogram (EEG)
6. MRI of brain
7. Needle Biopsy
8. Lumbar puncture
TREATMENT
• A brain abscess is a medical emergency.
• Pressure inside the skull may become high enough to be life
threatening.
• Patient need to stay in the hospital until the condition is stable.
• Some people may need life support.
Treatment…
Medication, not surgery, is recommended if patient have:
• Several abscesses (rare)
• A small abscess (less than 2 cm)
• An abscess deep in the brain
• An abscess and meningitis
• Shunts in the brain for hydrocephalus (in some cases the shunt may
need to be removed temporarily or replaced)
Medication
• Antibiotics will be prescribed.
• Antibiotics that work against a number of different bacteria (broad spectrum
antibiotics) are most commonly used.
• Antifungal medications may also be prescribed if the infection is likely caused
by a fungus.
• Immediate treatment may be needed if an abscess is injuring brain tissue by
pressing on it, or there is a large abscess with a large amount of swelling
around that it is raising pressure in the brain.
Surgery
• Surgery is needed if:
• Increased pressure in the brain continues or gets worse.
• The brain abscess does not get smaller after medication.
• The brain abscess contains gas (produced by some types of
bacteria).
• The brain abscess might break open (rupture).
Surgery…
• Surgery consists of opening the skull, exposing the brain, and draining the
abscess.
• Laboratory tests are often done to examine the fluid.
• This can help identify what is causing the infection, so that more
appropriate antibiotics or antifungal drugs can be prescribed.
Surgery…
• The surgical procedure used depends on the size and depth of the abscess.
• The entire abscess may be removed (excised) if it is near the surface and
enclosed in a sac.
Surgery…
• Needle aspiration guided by CT or MRI scan may be needed for a deep
abscess.
• During this procedure, medications may be injected directly into the mass.
• Certain diuretics and steroids may also be used to reduce swelling of the
brain.
Prognosis
• If untreated, a brain abscess is almost always deadly.
• With treatment, the death rate is about 10 - 30%.
• The earlier treatment is received, the better.
• Some patients may have long-term neurological problems after surgery.
Complications
1. Brain damage
2. Meningitis that is severe and life threatening
3. Return (recurrence) of infection
4. Seizures
QUESTION????
