Brain Abscess

Brain Abscess

Predisposing conditions
1. HIV
2. Immunosupressive drugs (e.g. solid organ or haematopoetic transplant)
3. Deep head infections
  1. Sinusitis
  2. Mastoiditis
  3. Dental abcess
4. Disrupted protective barrier
  1. Head trauma
  2. Brain surgery
5. Systemic infections
  1. Endocarditis
  2. Bacteraemia
Presentations
1. Headache earliest and most frequent symptom
2. Fever and reduced GCS often absent
3. Seizures in 25%
4. May or may not have neuro signs depending on absces size
5. Signs of systemic infection e.g. Pneumonia, sinusitis, mastoiditis, endocarditis may be present
Role of neurosurgery
1. Stereotactic aspiration aids in identifying pathogen
2. Decompression indicated if significant mass effect or coning
Antimicrobial therapy
1. Empirical therapy
  1. Standard regime
    1. Ceftriaxone and metronidazole
      1. Covering streps, bactericides, enterobacteriacae, haemophillus,
    2. Polymicorbial infections common, esp if source is sinus/mastoid.
  2. For transplant patients
    1. Standard regime
    2. Voriconazole
      1. covering aspergillus
    3. co-trimoxazole
      1. Covering nocardia
  3. HIV patients
    1. Standard regime
    2. pyrimethamine/sulfadiazine
      1. Covering T. Gondii
  4. Post-surgical or trauma
    1. Standard regime
    2. Vancomycin
      1. Covering staph aureus
2. Directed therapy
  1. Duration of therapy 6 weeks of IV
  2. Guaging treatment response
    1. Serial CT
      1. Approx every 2 weeks for 3/12
      2. Urgent scan if clinical deterioration
  3. Failure of treatment needs referral to neurosurgery for abcess respiration or excision
Complications
1. Rupture into ventricular system
  1. Causes hydrocephalus
  2. 70% mortality
2. Prophylactic anticonvulsants not recommended

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	Created by ben.ramsay over 10 years ago