Brain abscess

Question 1

What is a brain abscess

Answer 1

Focal, infectious intra cerebral colleciton of pus encapsulated in a well vascularised wall

Question 2

Where do brain abscess originate

Answer 2

Spread of infection from sinusitis, otitis media or dental infections
Haematogenous spread from distant eg endocarditis, pulmonary
Direct inoculation from trauma or neurosurgery

Question 3

Risk factors for brain bascess

Answer 3

Immunocompromise
R to L shunts eg congenital HD
Chronic otitis and sinusitis
IVDU

Question 4

Pathogeneses + of brain abscess

Answer 4

early/initial cerebritis (1-3 days), late cerebritis (4-9 days), early capsule formation (10-13 days), and late capsule formation (14 days onwards

Question 5

Clinical presentation of brain abscess

Answer 5

V variable - dependent on location, size, odedema aetc
HEADAHCE - dull, constant, progressive, localised
FOCAL NEUROLOGICAL - 50% DEFICITS
FEVER
Raised ICP signs - large

Alos - lethargy, altered mental status, seizures (cortical irritation if near cerebral cortex)

Question 6

Presentation of brain abscess in immunocomp

Answer 6

or multiple brain abscesses, the presentation may be more subtle, with fewer localising signs and symptoms.

Question 7

Raised ICP signs

Answer 7

nausea, vomiting, altered consciousness, and papilloedema,

Question 8

Diagnosis of brain abscess

Answer 8

CT - hydrocephalus and herniation
MRI + gadolinuim in early cerebritis
Steroetatic needle aspiration - daignose and treat

Question 9

What investigation is CI in brain abscess

Answer 9

LP - risk of brain herniation

Question 10

Management brain abscess

Answer 10

Surgery - craniotomy and debridement
IV antibiotics - 3rd gen cephalosporin + metronidazole
IC pressure management eg dexamethasone

Question 11

Complications of brain abcess

Answer 11

nclude seizures, meningitis, ventriculitis, hydrocephalus, cerebral oedema, and herniation.