1. Dr. Amanj Burhan specialist Neurosurgeon
BRAIN ABSCESS
Dr. Amanj Burhan
specialist Neurosurgeon
4/15/2017
Brain Abscess

2. CLINICAL PRESENTATION DIAGNOSIS MANAGEMENT OUTCOME
INCIDENCE:
ETIOLOGY
MICROBIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
OUTCOME
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Brain Abscess

3. 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 .
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Brain Abscess

4. 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)
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Brain Abscess

5. 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
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Brain Abscess

6. 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 ?
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Brain Abscess

7. Brain abscess from penetrating trauma is preventable or not?
B. Basal skull fracture with CSF leak and meningitis cause post traumatic abscess
Brain abscess from penetrating trauma is preventable or not?
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Brain Abscess

8. 5. Immune compromised person
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
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Brain Abscess

9. Otogenic and dental infection caused by anaerobic organism
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%
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Brain Abscess

10. 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
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Brain Abscess

11. 3.stage three (early encapsulation)(day10—13)
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 )
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17. 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
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Brain Abscess

18. 2. Change in conscious level ( 60 %) 3. FND ( 60 %)
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
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Brain Abscess

19. Laboratory findings WBC : normal or mild increase
ESR : increase in 90%
CSF : not specific
Opening pressure
Protein
Glucose
Culture
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Brain Abscess

20. 4. radiological characteristic of brain abscess
Brain CTS with contrast
ring enhancement
Multi loculation
Multiplicity
Finding of gas
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Brain Abscess

21. MRI : T1 : T2 : necrotic center ( hypointence) Capsule ( hyperintence)
Edema ( hypointence)
T2 :
necrotic center ( hyperintence)
Capsule ( hypointence)
Edema ( hyperintence
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Brain Abscess

22. 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)
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Brain Abscess

23. Advantage of antibiotic therapy
Small size
Deep seated
Multiple
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24. Remove of purulent material
2. Aspiration :
Advantages :
Confirm diagnosis
Remove of purulent material
Provide environment for antibiotics to work
Provide immediate relief of IICP
Stereotactic guided aspiration
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Brain Abscess

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26. 3.Excision of brain abscess Advantages
Traumatic abscess ( contain foreign body and bone fragment )
Fungal abscess
Gas containing abscess
Disadvantages
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27. CT weekly during antibiotic therapy And then monthly CT
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
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Brain Abscess

28. 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)
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29. 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)
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30. Thank you
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