Abscess of the brain
Last reviewed: 23.04.2024
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Brain abscess is the accumulation of pus in the brain substance. The disease manifests itself as headache, inhibition, increased body temperature and focal neurological deficit. The diagnosis is confirmed by CT with contrasting or MRI and sometimes by bacteriological examination. For treatment, antibacterial drugs and surgical drainage are used.
[Causes of the brain abscess
Brain abscess can occur as a result of direct contact spread of the infection (for example, in osteomyelitis, mastoiditis, sinusitis, subdural empyema), with penetrating head injuries (including neurosurgical interventions), as well as hematogenous (for bacterial endocarditis, congenital heart defects with discharge of blood on the right left, abuse of intravenous injections). Sometimes the entrance gates of infection remain unsettled.
Infectious agents are usually anaerobes, sometimes a mixed microflora, including anaerobic streptococci or bacteroides. Staphylococcal infection more often complicates the course of craniocerebral trauma, neurosurgical interventions or endocarditis.
Representatives of the family Enterobacteriaceae are isolated during otogennom infection. Abscesses can be caused by a fungal infection (for example, fungi of the genus Aspergillus) and protozoa (eg, Toxoplasma gondii, usually in HIV-infected individuals).
Brain abscess is formed as a result of necroticisation of a site of inflamed brain tissue, around which glia and fibroblasts form a capsule. Perifocal edema can cause an increase in intracranial pressure.
Symptoms of the brain abscess
Symptoms of brain abscess are due to increased intracranial pressure and mass effect (compression of the brain substance). For several days or weeks, headache, nausea, vomiting, retardation, epileptic seizures, mental changes, congestive optic discs and focal neurological symptoms develop.
Fever, chills and leukocytosis may decrease as soon as a capsule forms around the focus of infection.
Diagnostics of the brain abscess
If a brain abscess is suspected, CT with contrast or MRI is performed. The abscess looks like a puffy mass, surrounded by a ring-shaped formation, accumulating contrast, which can be difficult to differentiate from a tumor or a cerebral infarction; may require seeding and drainage.
Lumbar puncture is contraindicated, as it can cause transgenic wedge, in addition, the CSF study data have no diagnostic significance.
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Treatment of the brain abscess
The duration of antibiotic therapy is from 1 to 2 months. Empirically prescribed cefotaxime 2 g intravenously every 4 h or ceftriaxone 2 g intravenously every 12 h; both antibiotics are effective against streptococcal infection, representatives of the Enterobacteriaceae family and most anaerobes, but not with respect to the anaerobic Bacteroides fragilis, which requires metronidazole 7.5 mg / kg intravenously every 6 hours for overlapping.
In the case of staphylococcal infection (Staphylococcus aureus), the abscess of the brain is the drug of choice for vancomycin, 1 g every 12 h until the results of determining the sensitivity of the pathogen to nafcillin (2 g every 4 h).
Monitoring of the effectiveness of antibiotic therapy is carried out using serial CT or MRI.
Stereotactic or open drainage is the optimal intervention for single and surgically accessible abscesses, especially larger than 2 cm in diameter. With increasing intracranial pressure, the patient is given a short course of high doses of glucocorticoids. For the prevention of epileptic seizures prescribe anticonvulsants.