Abscesses of the brain and spinal cord

Abscess of the brain or spinal cord - a limited accumulation of pus in the cavity of the skull or spinal canal. Depending on the localization, abscesses can be intracerebral (accumulation of pus in the brain substance), subdural (located under the dura mater) or epidural (localized over the dura mater). Abscesses of the brain are met with a frequency of about 0.7 per 100 000 population per year.

Causes of abscesses of the brain and spinal cord

It is not always possible to isolate the causative agent of the infection from the contents of the brain abscess. In about 25% of cases, the contents of the abscess are sterile. Among the isolated pathogens of hematogenous abscesses, streptococci (aerobic and anaerobic) predominate, often in association with bacteroides (Bacteroides spp.). With hematogenous abscesses, due to the lung abscess, Enterobacteriaceae (in particular, Proteus vulgaris) is often found . The same pathogens are characteristic for otogenic abscesses.

Pathogenesis of abscesses of the brain and spinal cord

The main ways of penetration of the infection into the cavity of the skull and the spinal canal are as follows:

• hematogenous;
• open penetrating craniocerebral trauma or spinal trauma;
• purulent-inflammatory processes in the paranasal sinuses;
• infection of the wound after neurosurgical interventions.

Conditions for the formation of an abscess in the case of infection are the nature of the pathogen (virulence of the pathogen) and a decrease in the immunity of the patient. In developed countries, hematogenous abscesses are the most typical. In developing countries, brain abscesses are most often formed against the background of chronic inflammatory processes in adjacent tissues, which is associated with inadequate treatment of the latter. In approximately 25% of cases, it is not possible to establish a source that led to the formation of brain abscess.

Abscesses of the brain and spinal cord - Causes and pathogenesis

Symptoms of abscesses of the brain and spinal cord

The clinical picture with abscesses of the brain and spinal cord corresponds 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.

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.

Abscesses of the brain and spinal cord - Symptoms and Diagnosis

Treatment of abscesses of the brain and spinal cord

Treatment of cerebral abscesses can be conservative and surgical. The method of treatment depends primarily on the stage of development of the abscess, its size and localization.

In the stage of formation of the encephalitic focus (the duration of the anamnesis is up to 2 weeks), as well as with small (<3 cm in diameter) abscesses, conservative treatment is indicated. The usual tactic is empirical antibiotic therapy. Some surgeons prefer stereotactic biopsies for the final verification of the diagnosis and isolation of the pathogen.

Forecast

The prognosis for abscesses of the brain depends on many factors. Of great importance is the ability to determine the pathogen and its sensitivity to antibacterial drugs, which allows for directional pathogenetic therapy. An important role in the outcome of the disease is the reactivity of the organism, the number of abscesses, the timeliness and adequacy of therapeutic measures.

Abscesses of the brain and spinal cord - Treatment and prognosis

The lethality with brain abscesses is about 10%, disability is about 50%. Almost a third of surviving patients develop epileptic syndrome.

[1], [2], [3], [4]