Neuro - Brain abscess

Question 1

Brain Abscess (BA) - what is it?

Answer 1

An abscess is a collection of pus encapsulated by a pyogenic membrane

Question 2

Brain abscess (BA) - what are the most common causes?

Answer 2

Extension of sepsis from middle ear or sinuses

Trauma or surgery to the scalp

Penetrating head injuries

Embolic events from endocarditis

Question 3

BA - what are the clinical features?

Answer 3

The presenting symptoms will depend upon the site of the abscess

Abscesses have a considerable mass effect in the brain and raised intracranial pressure is common

• Raised ICP
• Headache - dull, persistent
• Fever - may be absent
• Focal neurology - oculomotor nerve palsy or abducens nerve palsy secondary to raised intracranial pressure
• Other features consistent with raised intracranial pressure:
  
  • nausea
  • papilloedema
  • seizures

Question 4

BA - investigations?

Answer 4

Imaging - CT

Question 5

BA - what is the surgical and pharmacological management?

Answer 5

• Surgery, craniotomy, abscess cavity debrided
• IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
  
  • Raised ICP management: Dexamethasone