Brain abscess — refers to focal purulent infections and is a limited accumulation of pus in the substance of the brain. Brain abscess is most often detected in immunocompromised patients with bronchiectasis, HIV infection, as well as “blue” heart defects (blood discharge from right to left) and hereditary hemorrhagic telangiectasia. Abscesses are most often intracerebral, sub- and epidural are less common.
Reasons
Abscess is caused by streptococci, pneumococci, staphylococci, meningococci. Occasionally, E. coli, proteus, mixed flora are sown.
About half of all cases are contact abscesses associated with a closely located purulent focus, and caused by infection of the paranasal sinuses, mastoid process, middle ear and other adjacent parts of the head. Otogenic brain abscess occurs in almost half of all cases of contact abscesses. Chronization of inflammatory processes in the ear dramatically increases the likelihood of complications with an abscess, compared with acute inflammation. Otogenic infection most often leads to an abscess of the temporal lobe of the brain, but it can also be localized in the cerebellum. Rhinogenic abscesses are characterized by damage to the frontal lobes of the brain. In more rare cases, abscesses are localized in deep parts of the brain, far from the primary focus, and infection of the brain occurs hematogenically due to venous thrombosis or arteritis.
Metastatic abscesses occur due to septic embolism and most often complicate lung diseases (bronchiectasis, pneumonia, empyema), but can also be associated with infectious endocarditis, osteomyelitis, abscesses of internal organs. In a third of cases, such abscesses are manifested by multiple foci in the deep parts of the brain.
Traumatic abscesses occur in an open (much less often closed) traumatic brain injury. An abscess is formed either when a foreign body penetrates into the cranial cavity along the wound canal or when the dura mater is damaged in the brain tissue, due to the spread of infection through the perivascular spaces and subsequent inflammation of the brain membranes.
Symptoms
1.General infectious – fever (sometimes intermittent; noted, as a rule, before the formation of an abscess capsule), chills, pallor, decreased appetite and body weight, general weakness.
2. Cerebral – most often these are headaches, less often hiccups, diplopia, stupor (up to coma), resulting from increased intracranial pressure. Vomiting of central genesis and transient bradycardia up to 40 beats / min are also noted, and when examining the fundus, stagnant discs or optic neuritis are detected. Convulsions in the form of an epileptic seizure can often be observed.
3. Focal – depend on the localization of the abscess in a certain area of the brain.
Diagnostics
Diagnosis, first of all, is based on anamnesis data (information about a purulent focus in the body, trauma) and the presence of symptoms of the disease. Laboratory diagnostics are also needed (leukocytosis in the UAC, increased levels of C-reactive protein, blood cultures), overview radiography of the thoracic cavity and paranasal sinuses, CT and MRI of the brain with contrast, fundus examination.
Treatment
Prior to encapsulation of the abscess (which can take from 4 to 6 weeks), exclusively conservative treatment is carried out in the form of intravenous administration of broad-spectrum antibiotics, followed by a switch to an antibiotic to which the infectious flora is sensitive. Since most abscesses are caused by mixed flora, a combination of 3rd generation cephalosporins, vancomycin and metronidazole is most often used.
After the abscess is encapsulated, a total removal of the abscess is carried out together with the capsule. Cerebellar abscesses (with such localization of the abscess, a dense capsule is rarely formed) and multiple abscesses require observation using MRI and immediate antibiotic therapy in large doses for 6 weeks.
