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Brain Abscess

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Mapa Mental sobre Brain Abscess, criado por ben.ramsay em 30-10-2014.
ben.ramsay
Mapa Mental por ben.ramsay, atualizado more than 1 year ago
ben.ramsay
Criado por ben.ramsay mais de 11 anos atrás
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Resumo de Recurso

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

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