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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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slide1

BRAIN ABSCESS

M.RASOOLINEJAD, MD

DEPATMENT OF INFECTIOUS DISEASE

TEHRAN UNIVERSITY OF

MEDICAL SCIENCE

slide2

BRAIN ABSCESS

Focal

&

Suppurative Process

in Brain Parenchyma

slide3

Anatomical Relationships of the Meninges

  • Bone
  • Dura Mater
  • Arachnoid
  • Pia Mater
  • Brain
  • Epidural Abscess
  • Subdural Empyema
  • Meningitis
slide4

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)

slide8

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
slide9

PATHGENESIS

  • Bacterial invasion of brain
  • (Parenchyma )
  • Preexisting or concomitant :
  • Ischemia &
  • Necrosis &
  • Hypoxia of brain tissue
slide10

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
slide13

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
slide15

PATHGENESIS

4 Stages Brain Abscess formation:

Stage 3

  • Early Capsule formation ( days 10 to13 )
  • Capsule formation
  • Ring-enhancing capsule ( Imaging )
slide18

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
slide20

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
slide21

CLINICAL PRESENTATIONS

  • Increased Intracranial Pressure:
  • Papilledema
  • Nausea
  • Vomiting
  • Drowsiness
  • Confusion
  • Meningismus:
  • When it has ruptured into

Ventricle or subarachnoid space

slide22

CLINICAL PRESENTATIONS

  • Focal neurologic deficit > 60%
  • Frontal lobe Hemiparesis
  • Mental status, Drowsiness
  • Temporal lobe  Dysphasia

Upper homonymous quadrantanopia

Ipsilateral headache

slide23

CLINICAL PRESENTATIONS

  • Focal neurologic deficit > 60%
  • Cerebellar  Nystagmus, Ataxia
  • Dysmetria, vomiting
  • Brain stem  Facial weakness,
  • Fever, Hemiparesis, Dysphagia,
  • Vomiting, Headache, Fever
slide24

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%
slide42

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
slide43

ANTIMICROBIAL THERAPY

  • Otitis media & Mastoiditis:
  • Metronodazole & 3rd Cephalosporin
  • Sinusitis:
  • Metronidazole & 3rd Cephalosporine
  • Dental Sepsis:
  • Penicillin & Metronidazole
slide44

ANTIMICROBIAL THERAPY

  • Penetrating trauma &Neurosurgury:
  • Vancomycin & 3rd Cephalosporin
  • Bacterial endocarditis:
  • Vancomycin & Gentamycin
  • Nafcilline (Oxacillin) & Ampicillin
  • & Gentamycin
  • Unknown:
  • Vancomycin & Metronidazole &

3rd Cephalosporin

slide45

PROGNOSIS

  • Successfully treatment 
  • Good prognosis
  • Seizures are a
  • common complication 70%
slide47

THE

END

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