Main Ways A Brain Abscess Can Develop
- An infection in another part of the skull: Such as an ear infection, sinusitis, or tooth abscess, which can spread directly to the brain
- An infection in another part of the body: When an infection spreads into the brain- such as pneumonia
- Trauma: A severe head or skull injury that cracks the skull, allowing bacteria to enter the brain
Its important to note that, in some cases, the source of the infection is unknown.
Risk Factors For Brain Abscess
Nearly anyone can get a brain abscess, but certain groups of people are at a higher risk than others. Some diseases, disorders, and conditions that raise your risk include:
- chronic sinus or middle ear infections
- congenital heart disease
Certain birth defects allow infections to reach the brain more easily through the teeth and intestines. One example of this is tetralogy of Fallot, which is a heart defect.
Infection Through The Bloodstream
Infections spread through the blood are thought to account for around 1 in 4 cases of brain abscesses.
People with a weakened immune system have a higher risk of developing a brain abscess from a blood-borne infection. This is because their immune system may not be capable of fighting off the initial infection.
You may have a weakened immune system if you:
- have a medical condition that weakens your immune system such as HIV or AIDS
- receive medical treatment known to weaken the immune system such as chemotherapy
- have an organ transplant and take immunosuppressant medicines to prevent your body rejecting the new organ
The most commonly reported infections and health conditions that may cause a brain abscess are:
- cyanotic heart disease a type of congenital heart disease where the heart is unable to carry enough oxygen around the body this lack of a regular oxygen supply makes the body more vulnerable to infection
- pulmonary arteriovenous fistula a rare condition in which abnormal connections develop between blood vessels inside the lungs this can allow bacteria to get into the blood and, eventually, the brain
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Diagnosis Of A Brain Abscess
Magnetic resonance imaging or computed tomography
Withdrawal and testing of a sample of pus from the abscess
If doctors suspect a brain abscess, magnetic resonance imaging is done before and after gadolinium is injected intravenously. Gadolinium makes abscesses easier to see on MRI scans. If MRI is unavailable, computed tomography can be done after a radiopaque contrast agent is injected intravenously. MRI has higher resolution and can show early abnormalities better than CT. However, additional tests may be needed to establish the diagnosis because a brain tumor or damage due to a stroke or multiple sclerosis can resemble a brain abscess.
To identify the causative organism and thus determine which drugs would be most effective, doctors withdraw a sample of pus from the abscess with a needle. It is examined under a microscope and sent to a laboratory to grow bacteria in the fluid so that they can be identified. MRI or CT is used to guide the needle into the abscess. For this procedure , a frame is attached to the skull. The frame provides reference points that can be identified on the MRI or CT scan. Thus, after drilling a small hole through the skull, doctors can guide the needle precisely into the abscess.
However, doctors do not wait to get the result of culture to start treatment.
Are You Sure Your Patient Has A Brain Abscess What Are The Typical Findings For This Disease
Brain abscess is a focal suppurative process of the brain parenchyma.The abscess begins initially as an area of focal inflammation, called cerebritis, which with time and without effective treatment progresses to an abscess. Brain abscesses usually develop in a four-stage process. These stages are early and late cerebritis and early and late capsule formation and represent a continuum rather than discrete steps. The evolution of this process is dependent on the causative organism, host immunologic status, and effective antimicrobial therapy.
Brain abscess is uncommon in infants and children, but delays in diagnosis and treatment are associated with death and/or permanent neurologic deficits. It is therefore important to pay close attention to patients with underlying infection in the oropharynx, middle ear, and paranasal sinuses who present with mental status changes, focal neurologic deficits, or seizure. Brain imaging studies should be performed. Magnetic resonance imaging with gadolinium contrast is more sensitive and specific than computed tomography with contrast.
Clinical manifestations are dependent on the age of patient, the location and size of the brain abscess, the virulence of the causative microorganism, and host immune status.
Neonates with brain abscess can present with only an enlarged head and subtle neurologic dysfunction.
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Diagnostics And Treatment Of Brain Abscess
A thorough history taking is of paramount importance to diagnose a brain abscess. Besides, the presence of an inflammatory process associated with the appearance and development of neurological symptoms is the basis for additional neuroimaging examination.
The accuracy of diagnosing pathology using CT of the brain depends on the stage of abscess formation in the early stages of the disease the diagnosis is difficult.
MRI of the brain is a more accurate method for diagnosing pathology.
Other diagnostic methods for this disease are of little informative leukocytosis, increased content of C-reactive protein in the blood, and fever this whole complex of symptoms can be attributed to almost any inflammatory process, including intracranial.
Treatment of brain damage. Treatment of brain abscesses can be both conservative and surgical the choice of tactics depends on the stage of development of the pathology, its location, and size.
- At the encephalitic stage of an abscess and in the case of a small brain abscess , conservative treatment is usually carried out based on empirical antibiotic therapy.
- Abscesses that cause dislocation of the brain increase intracranial pressure, and those located in the area of the ventricular system, have absolute indications for surgical intervention.
Traumatic brain abscesses localized in the foreign body area are also subject to surgical treatment since they do not respond to conservative treatment.
Brain Abscess Recovery Time
Once your brain abscess has been treated, youll probably stay in hospital for several weeks so your body can be supported while you recover.
Youll also receive a number of CT scans, to make sure the brain abscess has been completely removed.
Most people need a further six to 12 weeks rest at home before theyre fit enough to return to work or full-time education.
After treatment for a brain abscess, avoid any contact sport where theres a risk of injury to the skull, such as boxing, rugby or football.
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What Brain Abscess Treatment Options Are Available For Me
Affecting between 1,500 and 2,500 Americans each year, brain abscesses are a serious and potentially life-threatening condition. A brain abscess is a collection of fluid and pus that develops as a result of an infection or head trauma. As the abscess becomes larger, the patient will experience various symptoms resulting in a combination of infection, brain tissue damage, and pressure on the brain.
Brain Abscess Caregiver Tips
In severe cases, brain abscesses can result in profound symptoms and personality changes that may prevent the sufferer from functioning effectively in their daily lives. An abscess may also occur in conjunction with a brain injury or surgery that introduces their own demands and responsibilities on caregivers.
If you are a caregiver for a loved one with a brain abscess, keep these tips in mind:
- Attend doctor appointments with your loved one so that you can understand the diagnosis, the treatment plan, and the expectations for recovery.
- During recovery, provide a comfortable space for the sufferer free from noise, excessive stimulation, and stress.
- Work with your loved ones medical providers after treatment to learn how you can best support them as they recuperate. Understand the goals of any long-term therapies, and be realistic about expectations.
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How Is A Cerebral Abscess Diagnosed
Your healthcare provider will ask about your symptoms and may do a neurological exam to look for changes in motor and sensory function, vision, coordination and balance, mental status, and mood or behavior. They may also order a number of tests to diagnose a cerebral abscess:
- Magnetic resonance imaging or computed tomography scan of your head
- Blood tests to look for signs of germs and other signs of infection
- Tests of a sample from the abscess to determine the cause of your infection
Hematogenous Spread From A Distant Focus
These abscesses are more commonly multiple and multiloculated and are frequently found in the distribution of the middle cerebral artery. The most common effected lobes are the fontal, temporal, parietal, cerebellar, and occipital.
Hematogenous spread is associated with cyanotic heart disease , pulmonary arteriovenous malformations, endocarditis, chronic lung infections , skin infections, abdominal and pelvic infections, neutropenia, transplantation, esophageal dilatation, injection drug use, and HIV infection.
Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011. 9:136-44. .
Brouwer MC1, van de Beek D. Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis. 2917. 30:129-134. .
Nielsen H, Gyldensted C, Harmsen A. Cerebral abscess. Aetiology and pathogenesis, symptoms, diagnosis and treatment. A review of 200 cases from 1935-1976. Acta Neurol Scand. 1982 Jun. 65:609-22. .
Helweg-Larsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis. 2012. 12:332. .
Brook I, Friedman EM. Intracranial complications of sinusitis in children. A sequela of periapical abscess. Ann Otol Rhinol Laryngol. 1982 Jan-Feb. 91:41-3. .
Glickstein JS, Chandra RK, Thompson JW. Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg. 2006 May. 134:733-6. .
Bensalem MK, Berger JR. HIV and the central nervous system. Compr Ther. 2002 Spring. 28:23-33. .
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Can A Brain Abscess Be Cured
A brain abscess is treatable if you start treatment early.
Your doctor will take a clinical history, probably do blood work, and order an MRI of your brain. If the MRI shows a lesion, you will have a surgical procedure called a needle biopsy to take a sample of tissue. This will confirm that you have a brain abscess and tell the doctors what strains of bacteria you have. Your doctor will also remove as much bacteria as possible with the needle.
Once your doctor knows the exact strains of bacteria, they will give you targeted antibiotics to treat any bacteria that are left. It can take weeks or longer to get rid of the infection. If the surgeon finds a more widespread infection, they may perform a brain surgery called a craniotomy to remove all the bacteria.
If your doctor thinks you have had seizures, you may be given anti-seizure medications. You will also have a follow-up MRI to track your response to treatment. If there is an underlying cause for the abscess, like a heart valve infection , youll also need to have that treated.
Brain Abscess Survival Rate
The advent of antimicrobials and imaging studies as CT scanning and MRI, the mortality rate has reduced from 5% to 10% 4). Rupture of a brain abscess, however, is more fatal. The long-term neurological complications after the infection are dependent on the early diagnosis and administration of antibiotics.
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Ongoing Controversies Regarding Etiology Diagnosis Treatment
The optimal treatment of brain abscess, which includes the duration of antimicrobial therapy and need for surgical treatment, is currently determined individually based on causative pathogens, size of the abscess and response to treatment.
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If You Are Able To Confirm That The Patient Has A Brain Abscess What Treatment Should Be Initiated
Treatment requires a multidisciplinary approach involving pediatric intensivists, neurosurgeons, radiologists, and infectious disease specialists. Understanding the pathogenesis is important in determining the most likely causative microorganisms and subsequent treatment.
Empirical antimicrobial therapy should be started, particularly in patients with sepsis or impending herniation, but every effort should be made to obtain microbiologic and/or tissue diagnosis before initiating antimicrobial therapy.
Because brain abscesses are frequently polymicrobial, empirical therapy should cover gram-positive, gram-negative, and anaerobic organisms, normally with a third- or fourth-generation cephalosporin , metroniazole, and vancomycin, based on predisposing factors and epidemiologic characterisitics. Carbapenems can be used in lieu of the combination of cephalosporins and metroniazole. Once a causative organism is identified, antimicrobial therapy can be tailored, but coverage of anaerobic organisms should be continued even in the absence of an anaerobic isolate when the underlying infection is in the upper and lower respiratory tract.
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Treatments For Brain Abscess
A brain abscess is a serious medical situation. A stay in the hospital will be required. Pressure due to swelling in the brain can lead to permanent brain damage.
If your abscess is deep inside your brain or its 2.5 centimeters or less, it will probably be treated with antibiotics. Antibiotic medications will also be used to treat any underlying infections that may have been the cause of the brain abscess. Broad-spectrum antibiotics that kill a variety of different bacteria are the most commonly prescribed. You may need more than one type of antibiotic.
Surgery is often the next step if an abscess doesnt get smaller with the use of antibiotics. It may also be the preferred treatment for abscesses greater than 2.5 centimeters wide. Surgically removing an abscess usually involves opening the skull and draining the abscess. The fluid thats removed is normally sent to a lab to determine the cause of the infection. Knowing the cause of the infection will help your doctor find the most effective antibiotics. Surgery may also be necessary if antibiotics arent working, so that the organism causing the abscess can be determined to help guide the most effective treatment.
Surgery must be performed in the most severe cases when the abscess causes a dangerous buildup of pressure in the brain. Your doctor may recommend surgery as the best option in the following cases:
Treatment In Culture Negative Patients
The primary beta-lactam treatment among the 14 patients with negative cultures was a cephalosporin in 7 patients, a cephalosporin followed by penicillin in one case, penicillin in two cases and cephalosporin followed by meropenem in two cases all patients also received metronidazole. In addition, one patient was treated with chloramphenicol and one patient died immediately after admission. No clear association between empiric choice of treatment and outcome was found, six of the 14 patients died within three month, of which three patients had been treated with cephalosporins and one patient treated with a cephalosporin followed by penicillin.
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What Is Brain Abscess
Brain Abscess is a pathological condition in which there is an abscess formation within the brain as a result of a bacterial, fungal, or a viral infection. This infection may have started in the brain due a head injury resulting in an open wound which may have got contaminated or as a result of an infection somewhere else in the body that may have spread to the brain. Studies suggest that majority of the cases of Brain Abscess are caused due to an infection spreading to the brain from other parts of the body.Among the most frequent locations from where an infection can quickly spread to the brain are the heart and lungs, although an ear or a sinus infection may also cause Brain Abscess. Brain Abscess is an emergent medical condition and needs to be treated right away and any delay in treatment may lead to potentially serious complications like a ruptured abscess which may be life threatening and may cause some serious damage to the brain due to the swelling caused by the Brain Abscess.
What Caused This Disease To Develop At This Time
There are three major pathogenetic factors predisposing to brain abscess.
1. Contiguous spread: Brain abscesses most commonly are the result of contiguous spread of infection from the oropharynx , middle ear, and paranasal sinuses direct extension and, more commonly, retrograde thrombophlebitis through the valveless diploic veins. Brain abscesses are more common in children, adolescents, and young adults than in other age groups because they are likely to have highly vascular diploic bone, which increases valveless bidirectional flow between frontal sinus mucosa and the dural venous drainage.
2. Cranial trauma. The prevalence of brain abscess after penetrating trauma or neurosurgical procedures ranges from 2%-14%.
3. Hematogenous spread from distant focus of infection: Hematogenous spread can occur in the setting of endocarditis, cardiac shunts, chronic pyogenic lung infection, intraabdominal abscess, and urinary tract infections. Hematogenous abscesses are usually multiple, are identified at the gray-white matter junction, and are located in the middle cerebral artery distribution.
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Treatment Options And Prevention For A Brain Abscess
For those with brain abscesses, antibiotics and the drainage of abscess contents are often necessary.
- Antibiotics: People who have brain abscesses will require antibiotic medications to treat the infection. These antibiotic medications will need to be given for four to eight weeks and will need to be given through an IV because medications taken by mouth cannot reach high enough levels in the brain. A broad combination of antibiotics to cover many possible infectious organisms will be used to start and then subsequently narrowed down to a few antibiotics that target the specific organisms causing the infection. Possible antibiotic medications that may be given include metronidazole , ceftriaxone, meropenem, or vancomycin, among others. In some cases, the physician may add an antifungal medication in case a fungal organism is causing the infection.
- Aspiration of abscess contents: All people who have a brain abscess will also need either a procedure or surgery to remove the contents of the brain abscess. The less invasive way to do this is to aspirate the contents of the brain abscess using a needle. Anesthesia is given, a small hole is placed in the skull, and a needle is guided to the location of the abscess to drain the contents.