Brain abscesses Flashcards
What is a brain abscess?
a focal suppurative process within the brain parenchyma (pus in the substance of the brain)
In which four clinical settings can brain abscesses form?
- direct spread from contiguous suppurative focus
- haematogenous spread from a distant focus
- trauma
- cryptogenic
What is the clinical presentation of a brain abscess?
- headache
- focal neurological deficit
- confusion
- fever
- nausea, vomiting
- dizziness, seizures
- neck stiffness
- papilloedema, coma
How would you manage a brain abscess?
drainage is treatment of choice
Why is drainage of a brain abscess important?
- reduce intracranial pressure
- confirm diagnosis
- obtain pus for microbiological investigation
- enhance efficacy of antibiotics
- avoid spread of infection into ventricles
Which main antibiotics achieve therapeutic concentrations in intracranial pus?
ampicillin, penicillin, cefuroxime, cefotaxime, metronidazole
How long would you treat a drained abscess for?
4-6 weeks
What complications may occur with brain abscess?
raised intracranial pressure, mass effect, coning, rupture causing ventriculitis
What is subdural empyema?
infection between the dura and arachnoid mater
What causes subdural empyema?
anaerobes, streptococci, aerobic gram negative bacilli
How does subdural empyema present?
headache, fever, focal neurological deficit, confusion, seizure, coma
How would you manage subdural empyema?
urgent surgical drainage of pus and antimicrobial agents
What is the most common cause of VP and EVD infection?
coagulase-negative staphylococci
How would you treat VP and EVD infection?
device removal and intraventricular antibiotics
