BRAIN ABSCESS
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BRAIN ABSCESS. M.RASOOLINEJAD, MD DEPATMENT OF INFECTIOUS DISEASE TEHRAN UNIVERSITY OF MEDICAL SCIENCE. BRAIN ABSCESS. Focal & Suppurative Process in Brain Parenchyma. Anatomical Relationships of the Meninges. Bone Dura Mater Arachnoid Pia Mater Brain.

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Brain abscess

BRAIN ABSCESS

M.RASOOLINEJAD, MD

DEPATMENT OF INFECTIOUS DISEASE

TEHRAN UNIVERSITY OF

MEDICAL SCIENCE


Brain abscess

BRAIN ABSCESS

Focal

&

Suppurative Process

in Brain Parenchyma


Brain abscess

Anatomical Relationships of the Meninges

  • Bone

  • Dura Mater

  • Arachnoid

  • Pia Mater

  • Brain

  • Epidural Abscess

  • Subdural Empyema

  • Meningitis


Brain abscess

EPIDEMIOLOGY

  • Uncommon intracranial infections

  • Incidence 1:100,000/year

  • Predisposing conditions: Paranasal Sinusitis

  • Otitis Media

  • Dental infections

  • Immunocompromised pts Uncommon org

  • (T.gondii, Aspergillus spp, Nocardia spp, …)


Ethiology

ETHIOLOGY

  • Abrain abscess may develop:

  • Direct spread from a contagious cranial of infections

  • ( Paranasal sinusitis, Otitis media, Mastoiditis,…..)

  • 2. Following head trauma or Neurological procedure

  • 3. Hematogenous spread from remote site of inf

  • 4. No obivious primary source of inf ( 20-30% )

  • (Cryptogenic brain abscess )


Ethiology1

ETHIOLOGY

  • Most common organisms are :

  • Paranasal sinusitis:Microaerophilic &

  • Anaerobic strep

  • Haemophilus spp

  • Bacteroides spp

  • Fusobacterium spp

  • Dental infections: Streptococci spp

  • Prevetella

  • Prophyromanas


Ethiology2

ETHIOLOGY

Most common organisms are :

Otitis media & Mastoiditis:

Streptococci

Bacteroides spp

P. aeroginosa

Enterobacteriaceae

Hematogenous: S. Viridance

S. Aureous

Neurosergical procedure & open head trauma:

(S. aureous, Enterobactericeae, P. aeroginosa)


Brain abscess

SOURSE OF BRAIN ABSCESS

  • Frontal lobe:Frontal & Ethmoidal & Sphenoidal sinuses

  • Dental infections

  • Temporal lobe: Middle ear, Mastoid, Maxillary sinuses

  • Cerebellum & Brain Stem: Middle ear & Mastoid

  • Posterior Frontal or Parietal lobes:

  • Middle Cerebral Artery

  • Gray- White matter

  • Often multiple


Brain abscess

PATHGENESIS

  • Bacterial invasion of brain

  • (Parenchyma )

  • Preexisting or concomitant :

  • Ischemia &

  • Necrosis &

  • Hypoxia of brain tissue


Brain abscess

PATHGENESIS

4 Stages Brain Abscess formation:

Stage 1

  • Early cerebritis ( days 1 to 3 )

  • Prevascular infiltration of inflammatory cells

  • Central core of coagulative necrosis

  • Marked edema surrounds the lesions


Brain abscess

Early Cerebritis


Brain abscess

Early cerebritis


Brain abscess

PATHGENESIS

4 Stages Brain Abscess formation:

Stage 2

  • Late cerebritis ( days 4 to 9 )

  • Pus formation ( necrotic center )

  • Macrophages & Fibroblastrs

  • Thin capsule ( Fibroblast & Reticular fibers )

  • Marked edema around the lesions


Brain abscess

Late Cerebritis


Brain abscess

PATHGENESIS

4 Stages Brain Abscess formation:

Stage 3

  • Early Capsule formation ( days 10 to13 )

  • Capsule formation

  • Ring-enhancing capsule ( Imaging )


Brain abscess

Early Capsule formation


Brain abscess

PATHGENESIS

4 Stages Brain Abscess formation:

Stage 4

  • Late Capsule formation ( > 14 days )

  • Well formed necrotic center

  • Dense peripheral collagenous capsule

  • No cerebral edema

  • Marked gliosis & reactive astrocytes

  • Gliosis  Seizures


Brain abscess

CLINICAL PRESENTATIONS

Brain abscess presents as an

Expanding Intracranial mass

  • Headache > 75%

  • Constant, Dull,

  • Aching sensation

  • Hemicranial or General

  • Progressive  Refractory

  • Fever: 50% & Low grade

  • Seizure: New onset

  • Focal or Generalized


Brain abscess

CLINICAL PRESENTATIONS

  • Increased Intracranial Pressure:

  • Papilledema

  • Nausea

  • Vomiting

  • Drowsiness

  • Confusion

  • Meningismus:

  • When it has ruptured into

    Ventricle or subarachnoid space


Brain abscess

CLINICAL PRESENTATIONS

  • Focal neurologic deficit > 60%

  • Frontal lobe Hemiparesis

  • Mental status, Drowsiness

  • Temporal lobe  Dysphasia

    Upper homonymous quadrantanopia

    Ipsilateral headache


Brain abscess

CLINICAL PRESENTATIONS

  • Focal neurologic deficit > 60%

  • Cerebellar  Nystagmus, Ataxia

  • Dysmetria, vomiting

  • Brain stem  Facial weakness,

  • Fever, Hemiparesis, Dysphagia,

  • Vomiting, Headache, Fever


Brain abscess

DIAGNOSIS

NEUROIMAGING STUDIES

  • Brain CT- Scan

  • MRI ( Early cerebritis, Posterior Fossa)

  • Steriotactic Needle aspiration

  • Lumbar puncture  Risk of Herniation

  • CSF  Non Specific

  • Peripheral leucocytosis: 50%

  • Elevated ESR: 60%


Brain abscess

Left parietal abscess


Brain abscess

Marked edema


Brain abscess

Ring Enhancement


Brain abscess

Multiple abscess in a 6 years old boy


Brain abscess

Presumed source of polymicrobial abscess


Brain abscess

Cerebellar Abscess


Brain abscess

Mixed Abscess Location


Brain abscess

T. Gondii Encephalitis


Brain abscess

T. Gondii Encephalitis


Brain abscess

T. Gondii Encephalitis


Brain abscess

TREATMENT

SURGICOMEDICAL

  • Aspiration Or Open Drainage

  • Empirical Combination

  • Antimicrobial Therapy

  • Duration: 6 to 8 wks IV

  • Prophylactic Anticonvulsant Therapy

  • Glucocorticoids( Severe Edema & ICP )

  • Serial CT-Scan or MRI


Brain abscess

ANTIMICROBIAL THERAPY

  • Otitis media & Mastoiditis:

  • Metronodazole & 3rd Cephalosporin

  • Sinusitis:

  • Metronidazole & 3rd Cephalosporine

  • Dental Sepsis:

  • Penicillin & Metronidazole


Brain abscess

ANTIMICROBIAL THERAPY

  • Penetrating trauma &Neurosurgury:

  • Vancomycin & 3rd Cephalosporin

  • Bacterial endocarditis:

  • Vancomycin & Gentamycin

  • Nafcilline (Oxacillin) & Ampicillin

  • & Gentamycin

  • Unknown:

  • Vancomycin & Metronidazole &

    3rd Cephalosporin


Brain abscess

PROGNOSIS

  • Successfully treatment 

  • Good prognosis

  • Seizures are a

  • common complication 70%


Brain abscess

THE

END


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