Brain Abscesses

Question 1

Commonest cause of brain abscesses

Answer 1

Streptococci

Question 2

Causative organisms of brain abscesses

Answer 2

Streptococci
Staph A
gram -ve enteric bacteria (E.coli, pseudomonas)
Fungi
M. TB
Toxoplasma gondii

Question 3

4 clinical explanations for brain abscesses

Answer 3

1. Direct spread from ‘contiguous’ supporative focus
2. Haematogenous spread from a distant focus e.g. endocarditis, bronchiectasis
3. Trauma
4. Cryptogenic- no explanation

Question 4

Clinical presentation for brain abscesses

Answer 4

Headache, focal neurological deficit, confusion, fever, nausea, vomiting, dizziness, seizures, neck stiffness, papilloedema, coma

Question 5

Management of small brain abscesses

Answer 5

Antibiotics

Question 6

Management of large brain abscesses

Answer 6

Drainage, anitbiotics

Question 7

Which drugs achieve therapeutic concentrations in intracranial pus?

Answer 7

Ampicillin, penicillin, cefuroxime, cefotazidime, metronidazole

Question 8

Treatment for sinugenic/odontogenic abscess

Answer 8

Cefotaxime, metronidazole

Question 9

Treatmnet for otogenic abscess

Answer 9

Benzylpenicillin, cetazidime, metronidazole

Question 10

Complications of abscesses in the brain

Answer 10

Increased intracranial pressure

Ruptures (usually into ventricles) causing ventriculitis

Question 11

Infection between dura and arachnoid mata

Answer 11

subdural empyema

Question 12

Causes of subdural empyema

Answer 12

Strep.pneumo, H.influenzae, Staph A

Question 13

Pathogeneisis of subdural empyema

Answer 13

Spread of infection from
sinuses
middle ear and mastoid
distant site e.g. haematogenous or following surgery or trauma

Question 14

Cause of brain abscesses in neurosurgical patients

Answer 14

Ventriculoperitoneal shunt (VP) and external ventricular drain (EVD) infection

Question 15

Most common causative organism of ventriculoperitoneal shunt and external ventricular drain?

Answer 15

Coagulase -ve staphylococci