Wednesday, March 3, 2010
Brain Abscess
8:22 PM | 
Diposkan oleh
Hermanto
Brain abscess affects the brain's parenchyma directly, whereas parameningeal infections produce suppuration in potential spaces covering the brain and spinal cord (epidural abscess and subdural empyema) or produce occlusion of the contiguous venous sinuses and cerebral veins (cerebral venous sinus thrombosis).
The condition that predispose to the development brain abscess are : otogenic (otitis media, mastoiditis), dental (dental abscess), penetrating or non penetrating head injury, cerebral infarction and tumor, post operative neurosurgical procedure, sinus (sinusitis), cardiac (infective endocarditis), pulmonary (lung abscess, bronchiectasis).
Clinical manifestation that usually present are fever, meningeal sign, increasing intracranial mass effect (nausea, depressed level of consciousness, and papilledema). Focal neurologic deficits depend on the site of the lesion, which in turn will be determined by the causal or predisposing condition. Headache is an important initial symptom in 80 to 90% of patients with bacterial abscess.
Examination of the cranium, ears, paranasal sinuses, oral cavity, heart, and lungs may provide important clues to the etiology. lumbar puncture is contraindicated for patients with signs of increased intracranial pressure. Cultures of blood and sputum may identify the organism and its antimicrobial sensitivity.
Magnetic resonance imaging (MRI) allows detection of early changes, such as brain edema, and is preferable to computed tomography (CT).
Brain abscess need urgent intervention. Because of the risk for cerebral herniation with large lesions, treatment of cerebral edema (intravenous dexamethasone) may be needed even while initiating surgical intervention.
Nonsurgical treatment may be considered in patients with : small lesion size, an already identified pathogen, no symptoms or signs of increased intracranial pressure requiring neurosurgical intervention, a deep or inaccessible lesion, multiple abscesses, a contraindication to surgery (e.g., a bleeding diathesis).
Factors associated with a poor prognosis include age, multiple abscesses, and diagnostic delay in the absence of systemic signs of infection.
