19. Brain abscess

Question 1

What is brain abscess?

Answer 1

An abscess caused by infl. and collection of infected material, coming from

• Infection from ear, paransal sinuses or mastoid cells
• Dental or epidural abscess
• Infection from a skull fracture (trauma or surgical)

Question 2

Symptoms

Answer 2

Headache, drowsiness, confusion, seizures, hemiparesis or speech
Fever

Question 3

Causes

Answer 3

Nearby sites of infection
Bacterial endocarditis
Respiratory pathogen
Abscesses from trauma are from skin flora
Mixture of aerobic or anaerobic pathogens

Question 4

Diagnosis

Answer 4

CT or MRI w/IV contrast –> mass lesion surrounded by ring enhancement and signs of central necrosis within brain parenchyma.
SPECT to distinguish from neoplastic mass
Blood culture or neurosurgical drainage –> pathogen

Question 5

Treatment

Answer 5

IV antibiotics broad-spectrum; ceftriaxone or cefotaxime plus metronidazole
Stereotactic aspiration or surgical drainage