Brain abscess

The cerebral abscess (abscessus cerebri) is an inflammatory process directly within the brain parenchyma.

Penetration of inflammation
Inflammation can go to the brain:
 * directly through the bone in chronic inflammation of the paranasal sinuses and middle ear
 * penetrating craniocerebral injury or post-traumatic cerebrospinal fluid
 * [[File:Brain Abscess at MRI (T1 + contrast) -- showing a small ring-enhancing lesion with mild surrounding edema adjacent to the ventricular catheter and ventricular dilatation..jpg|thumb|Brain abscess]]hematogenous transmission from a distant inflammatory deposit (chronic bronchitis, bronchiectasis and lung abscess, infectious endocarditis, in a young patient it can be HIV infection, immunodeficiency or drug abuse)

Pathogens
Brain abscess can be caused by Staphylococcus epidermidis, Staphylococcus aureus (post-traumatic abscess), mixed flora incl. anaerobes, enterobacteria.

Symptoms
Symptoms are usually non-specific, but they can also be intracranial hypertension (headaches, mental changes, disorder of consciousness) or focal neurological deficit.

Diagnostics

 * the anamnesis is important
 * CT, MRI (collagen hyperdense capsule and hypodense center with pus)

Differential diagnostics

 * metastasis
 * glioblastoma
 * hematoma

Laboratory finding
Uncharacteristic, blood culture often negative, there may be leukocytosis in the blood count, CSF examination is abnormal in 90% of cases, but uncharacteristic.

Therapy
Microbiological examination of the puncture and subsequent targeting of ATB treatment is important, samples are sent for examination for aerobic and anaerobic cultures, fungal and TB (tuberculosis) examinations. Puncture of the abscess and suction of its contents. In the case of a large abscess on the surface of the brain, open resection (including capsule)
 * Surgical treatment

Long-term, 2–4 months, with the intravenous phase lasting 6 weeks, the effect of treatment is checked by repeated CT examinations.
 * The capsule is a barrier preventing the achievement of effective ATB concentrations within the abscess → ATB treatment
 * ATB treatment

Lethality
Today, the lethality is around 10%. Neurological deficit or epilepsy persists in 30% of patients after successful treatment.

Related articles:

 * Meningitis purulenta
 * Viral infections of the nervous system

References:

 * SAMEŠ, M, et al. Neurochirurgie. 1. vydání. Praha : Jessenius Maxdorf, 2005.  ISBN 80-7345-072-0.