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Brain abscess

Definition:

  • A brain abscess is a localized collection of pus in the brain parenchyma, usually caused by a bacterial or fungal infection.

Epidemiology:

  • Relatively rare but can be life-threatening.
  • Can occur at any age, but more common in young and middle-aged adults.

Etiology:

  • Commonly results from the spread of infection from nearby structures, such as the ears, sinuses, or teeth.
  • Hematogenous spread from a distant site of infection (e.g., endocarditis).
  • Direct infection following head trauma or neurosurgery.
  • Immunocompromised states increase the risk.

Pathophysiology:

  • The infection leads to an inflammatory response, collection of pus, and formation of a capsule.
  • The abscess can cause increased intracranial pressure, brain tissue displacement, and can lead to herniation if untreated.

Clinical Features:

  • Headache (most common symptom), fever, nausea, and vomiting.
  • Focal neurological deficits depending on the abscess location.
  • Altered mental status or seizures in severe cases.

Diagnosis:

  • MRI with contrast is preferred for better delineation of the abscess.
  • CT scan can also be used, especially in emergency settings.
  • Blood cultures and cultures from primary sources of infection.
  • Stereotactic aspiration may be necessary for both diagnosis and treatment.

Management:

  • Antimicrobial therapy is the cornerstone of treatment. Empiric antibiotic therapy should be broad-spectrum and adjusted based on culture results.
  • Surgical intervention (aspiration or excision) may be necessary, especially for larger abscesses or those not responding to antibiotics.
  • Management of raised intracranial pressure is critical.

Prognosis:

  • Depends on the size and number of abscesses, the organism responsible, the patient’s immune status, and how quickly treatment is initiated.
  • Early diagnosis and treatment improve outcomes.

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