Brain and spinal cord abscesses: symptoms and diagnosis
Last reviewed: 23.04.2024
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Symptoms of abscesses of the brain and spinal cord
Symptoms of abscesses of the brain and spinal cord correspond to the clinical picture of volumetric education. There are no pathognomonic symptoms of brain abscess. As with other voluminous formations, clinical symptoms can vary widely - from headache to development of severe cerebral symptoms with oppression of consciousness and expressed focal symptoms of brain damage. The first manifestation of the disease can be an epileptiform fit. Subdural abscesses and empyema are more likely to have meningeal symptoms. Epidural abscesses are almost always associated with osteomyelitis of the bones of the skull. Typically, a progressive increase in symptoms. In some cases, it can be very fast.
Diagnosis of abscesses of the brain and spinal cord
When making a diagnosis, it is important to carefully collect the history. The appearance and growth of neurological symptoms in a patient with a diagnosed inflammatory process is an occasion for carrying out a neurovisual examination.
CT scan. The accuracy of the diagnosis of brain abscess in CT depends on the stage of development of the process. With encapsulated abscesses, the accuracy of the diagnosis is close to 100%. The abscess has the appearance of a rounded volumetric formation with clear, even, thin contours of increased density (fibrous capsule) and a zone of reduced density in the center. In some cases, a clear liquid level is determined in the abscess cavity. On the periphery of the capsule, the zone of edema is visible. When a contrast medium is administered, it accumulates in the form of a thin ring corresponding to a fibrous capsule with a small adjacent gliosis zone. When the CT is repeated after 30-40 minutes, the accumulation of contrast medium is not determined.
Diagnosis in earlier stages is less reliable. In the stage of early encephalitis (1-e-3-day) with CT, a zone of reduced density, often of irregular shape, is detected. When the contrast medium is introduced, its accumulation occurs unevenly, mainly in the peripheral parts of the focus, but sometimes also in its center.
In the stage of late encephalitis (4-9th day), the contours of the focus become more even and more rounded, and the accumulation of contrast medium along the periphery of the focus is more intense and uniform. The X-ray density of the central zone of the focus immediately after the administration of contrast medium does not change, but with repeated CT after 30-40 minutes, it is possible to detect diffusion of contrast in the center of the focus, and also its preservation in the peripheral zone, which is not typical for tumors.
When analyzing a computer tomogram, it should be borne in mind that glucocorticoids, often used in treatment, significantly reduce the accumulation of contrast medium in the encephalitic focus.
Magnetic resonance imaging. MRI is a more accurate method of diagnosing abscesses than CT scan. The encephalitic focus looks hypoinstantive on T1 and hyperintense - on T2-weighted images. The encapsulated abscess on T1-weighted images looks like a zone of a reduced signal in the center and on the periphery, in the zone of edema, with the annular zone of a moderately hyperintensive signal between them, corresponding to the capsule of the abscess. On T2-weighted images, the central abscess zone is iso- or hypo-intensive, the peripheral zone of edema is hyperintensive, and a clearly defined capsule is traced between these zones.
Differential diagnostics
Differential diagnosis of the abscess should be carried out with primary glial and metastatic brain tumors. If there is a doubt about the diagnosis and the need for differentiation of the abscess, an important role is played by MP-spectroscopy (differential diagnosis is based on different amounts of lactate and amino acids in abscesses and tumors).
If you suspect a brain abscess, you should carefully examine the patient to identify all possible foci of inflammation that can become a source of intracranial infection.
Other methods of diagnosis and differential diagnosis of brain abscess are poorly informative. Fever, an increase in ESR, leukocytosis, an increase in the content of C-reactive protein in the blood can occur in any inflammatory process, including with extracranial processes. Blood cultures with abscesses of the brain are usually sterile. Lumbar puncture in the diagnosis of intracranial abscesses is not used today due to low informativeness (in most cases, the inflammatory process in the brain is delimited and not accompanied by meningitis) and the danger of a brain dislocation.
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