dr amanj burhan specialist neurosurgeon n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Dr. Amanj Burhan specialist Neurosurgeon PowerPoint Presentation
Download Presentation
Dr. Amanj Burhan specialist Neurosurgeon

Loading in 2 Seconds...

play fullscreen
1 / 30

Dr. Amanj Burhan specialist Neurosurgeon - PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on

BRAIN ABSCESS. Dr. Amanj Burhan specialist Neurosurgeon. INCIDENCE: ETIOLOGY MICROBIOLOGY PATHOGENESIS CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT OUTCOME. INCIDENCE. Is 1-2% of SOL in brain (USA) Is 8% (INDIA) Decreased incidence (because of antibiotic and improved life)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Dr. Amanj Burhan specialist Neurosurgeon' - imani-watts


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
dr amanj burhan specialist neurosurgeon

BRAIN ABSCESS

Dr. Amanj Burhan

specialist Neurosurgeon

Brain Abscess

slide2

INCIDENCE:

  • ETIOLOGY
  • MICROBIOLOGY
  • PATHOGENESIS
  • CLINICAL PRESENTATION
  • DIAGNOSIS
  • MANAGEMENT
  • OUTCOME

Brain Abscess

incidence
INCIDENCE
  • Is 1-2% of SOL in brain (USA)
  • Is 8% (INDIA)
  • Decreased incidence (because of antibiotic and improved life)
  • Lastly increased incidence because of opportunistic infection in immune compromised patient .

Brain Abscess

etiology
ETIOLOGY

1.Infection :

From PNS ,middle ear and mastoid

Characterized by solitary and located superficially

Infection spread by either direct or through veins(thrombophlibitis of diploic vein)

PNS (frontal and temporal lobe )

Middle ear (temporal lobe)

mastoid (temporal lobe and cerebellum)

Brain Abscess

slide5

2. Heamatogenous

  • hematogenous dissemination microorganism from remote site of infection
  • The abscess are multiple and deeply located
  • Mostly located in the frontal and parietal lobe?
  • Primary foci include (skin pustule ,pulmonary infection , diverticulitis …etc.
  • In Cyanotic cong. Heart dis. Brain abscess is leading cause of mortality and morbidity
  • Most common type of CHD. Is TOF 50%
  • Brain abscess in CHD are generally solitary

Brain Abscess

slide6

3. Penetrating trauma :

A. Penetrating trauma are seen occur soon or after years from trauma.

Contaminated bone fragments and debris provide anidus for infection

Bullet cause brain abscess or not ?

Brain Abscess

slide7

B. Basal skull fracture with CSF leak and meningitis cause post traumatic abscess

  • Brain abscess from penetrating trauma is preventable or not?

Brain Abscess

slide8

4.Previous craniotomy

Because of :

A. Introduce of M.O.at time of surgery

B. Spread of M.O. intracranialy through the wound

C. Bone flap infection

5. Immune compromised person

Brain Abscess

slide9

MICROBIOLOGY

  • Otogenic and dental infection caused by anaerobic organism
  • Sinusitis caused by staph aureus, aerobic streptococci
  • CHD caused by strep. SPP.
  • In immune deficiency caused by fungus
  • In AIDS by toxoplasma gondi
  • Incidence of –ve culture is 25-30%

Brain Abscess

pathogenesis and histopathology of brain abscess
PATHOGENESIS AND HISTOPATHOLOGY OF BRAIN ABSCESS
  • Preceding antibody formation there is an area of necrosis which is seeded by bacteria
  • Brain abscess formation are 4 stages

1.stage I:early cerebritis(day 1 to day 3) characterized by necrotic tissue ,local inflammatory response, marked edema This stage there is no demarcation between the lesion and surrounding brain

Brain Abscess

slide11

2.stage two (late cerebritis)(day 4-10): characterized by : pus , maximum edema

3.stage three (early encapsulation)(day10—13)

Capsule limits spread of infection

Capsule develops slowly in medial wall of abscess?

4.Stage four: late capsule stage ( day 14 and on )

Brain Abscess

slide17

Clinical presentation :

  • Occur in majorities in the first 2 decades of life
  • Males more affected ( cause is unknown )
  • adults depend on immune status
  • Infants : increase in head circumference , bulging fontanel , separation of cranial sutures , vomiting , irritability , seizures
  • Signs of IICP and FND :
            • Edema
            • Cerebral tissue destruction

Brain Abscess

slide18

Symptoms :

1. Head ache ( 90 %)

2. Change in conscious level ( 60 %)

3. FND ( 60 %)

        • Parietal lobe : hemiparesis
        • Temporal lobe : dysphasia
        • Cerebellar : ataxia and nystagmus

4.Fever (more than 50 %)

5. Nausea and vomiting ( 50 %)

6. Seizure ( 50 %)

7.Papilledema and meningismus

Brain Abscess

laboratory findings
Laboratory findings
  • WBC : normal or mild increase
  • ESR : increase in 90%
  • CSF : not specific
      • Opening pressure
      • Protein
      • Glucose
      • Culture

Brain Abscess

slide20

4. radiological characteristic of brain abscess

  • Brain CTS with contrast
      • ring enhancement
      • Multi loculation
      • Multiplicity
      • Finding of gas

Brain Abscess

slide21

MRI :

  • T1 :
      • necrotic center ( hypointence)
      • Capsule ( hyperintence)
      • Edema ( hypointence)
  • T2 :
      • necrotic center ( hyperintence)
      • Capsule ( hypointence)
      • Edema ( hyperintence

Brain Abscess

management
Management
  • Antibiotic therapy :
  • Antibiotic is mandatory and should given
  • Antibiotics depends on C/S
  • Imperial treatment depend on the etiology
    • Sinusitis : ( penicillin + metronidazole )
    • Otitis : ( penicillin + metronidazole + 3rd generation cephalosporin)
    • Metastatic abscess :(metronidazole + 3rd generation cephalosporin)
    • Post traumatic abscess ( vancomycin)

Brain Abscess

slide23

Advantage of antibiotic therapy

      • Small size
      • Deep seated
      • Multiple

Brain Abscess

slide24

2. Aspiration :

  • Advantages :
  • Confirm diagnosis
  • Remove of purulent material
  • Provide environment for antibiotics to work
  • Provide immediate relief of IICP
  • Stereotactic guided aspiration

Brain Abscess

slide26

3.Excision of brain abscess

  • Advantages
  • Traumatic abscess ( contain foreign body and bone fragment )
  • Fungal abscess
  • Gas containing abscess
  • Disadvantages

Brain Abscess

slide27

Follow up

  • CT weekly during antibiotic therapy
  • And then monthly CT
  • 2-3 week decrease size of abscess
  • 3-4 months complete resolution of abscess
  • 6-9 months no residual contrast enhancement

Brain Abscess

outcome of abscess
Outcome of abscess :

Mortality influenced by ( herniation , rupture of abscess to the ventricle , clinical course of the patient, type of abscess, neurological state of patient at time of diagnosis)

Brain Abscess

slide29

Long term morbidity : ( seizure , FND, Cognitive dysfunction)

  • Recurrence: ( 5-10%) causes ( inadequate antibiotic therapy, incorrect choice of AB, presence of foreign body , failure to eradicate source of the abscess)

Brain Abscess

slide30

Thank you

Brain Abscess