Brain Abscess Flashcards
What is a brain abscess?
suppurative collection of microbes within a gliotic capsule occurring within the brain parenchyma.
Describe the epidemiology of brain abscesses
M > F
<30y
List 4 causes of brain abscess
Extension of sepsis from middle ear/ sinuses
Trauma/ surgery to scalp
Penetrating head injury
Embolic event from endocarditis
When do brain abscesses present earlier?
Those located in critical areas e.g. motor cortex
Give 3 symptoms of brain abscess
Headache: dull, persistent
Nausea
Seizure
Give 3 signs of brain abscess
Focal neurology: oculomotor nerve/ abducens palsy secondary to raised ICP
Papilloedema
+/- fever
What bloods should be ordered in suspected brain abscess?
FBC
U+Es, CRP
Coagulation profile
What imaging is performed in suspected brain abscess?
CT head: ring enhancing lesion(s)
(MRI more sensitive for posterior fossa + early stages)
Describe management of brain abscesses
IV Abx
+/- dexamethasone
+/- anticonvulsant
Surgical decompression
Which antibiotics are used for brain abscesses?
Vancomycin
+
Metronidazole/ Clindamycin
+
Ceftriaxone
What anticonvulsant can be used in patients with brain abscesses?
Levetiracetam
In which brain abscess patients are anticonvulsants indicated?
Those who have had a seizure
Those with abscess near motor cortex/ brain surface
What is the purpose of dexamethasone in treatment of brain abscesses?
Rapid reduction in vasogenic oedema
Reduces ICP
When is surgical evacuation indicated for brain abscesses?
1st line for abscess >2.5cm diameter
2nd line for smaller abscesses refractory to medical Tx
List 5 complications of brain abscesses
Ventriculitis
Hyponatraemia
Seizures
Hydrocephalus
Death
