NS Infection - Brain Abscess/Empyema & HIV Flashcards

1
Q

Difference between brain abscess and empyema?

A

Abscess if localised pus in the brain

Empyema is usually a thin layer of pus between dura & Arachnoid

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2
Q

How does a brain abscess/empyema present?

A
  • Fever
  • Headache
  • Focal Signs e.g. seizures or dysphasia or weakness
  • Raised ICP (Papilloedema, depressed consciousness)
  • ~Meningism with empyema
  • Underlying source infection (Dental, ear, sinus)
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3
Q

Whats the DDX for a brain abscess?

A

Any other focal lesion e.g. tumour or subdural haematoma

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4
Q

Causes of Brain abscess/empyema?

A
  • Adjacent infection (Dental, Ear, Sinus)
  • Blood born infection (e.g. endocarditis)
  • Neurosurgical procedures
  • Penetrating head injury
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5
Q

How do we approach a suspected brain abscess or empyema?

A
  • CT/MRI
  • Investigate any source infection
  • Blood culture
  • Biopsy (Drainage) for culture & Sensitivity tests
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6
Q

Describe the bacteria in a brain abscess

A

Often mixtures of organisms

  • Streptococci, mainly Strep Milleri group (E.g. Strep Constellatus)
  • Anaerobes such as bacteroides
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7
Q

We’ve investigated our brain abscess, our do we treat it?

A
  • Surgical drainage if possible

Multiple High Dose Abx:

  • Penicillin or Ceftriaxone for Streptococci
  • Metronidazole for Anaerobes
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8
Q

Patient’s with HIV can present with a lot of unusual Nervous conditions such as?

A
  • Cerebral Toxoplasmosis
  • Aseptic Meningitis/Encephalitis
  • Cerebral Lymphoma
  • Cerebral Abscess
  • Cryptococcal Meningitis
  • Dementia
  • Leucoencephalopathy
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9
Q

How would we investigate a patient with CNS manifestations we suspect to be HIV related?

A
  • India Ink for cryptococcal Antigen
  • Toxoplasmosis Serology (IgG)
  • PCR for JC virus, CMV & HIV
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10
Q

What brain infections are likely in HIV patients with a low CD4 count?

A
  • Cryptococcus neoformans
  • Toxoplasma gondii
  • Progressive multifocal leukoencephalopathy (PML)
  • Cytomegalovirus (CMV)
  • HIV-encephalopathy (HIV-associated dementia)
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