Brain abscess - diagnosis, treatment


1. Etiology and pathogenesis

2. Symptoms and diagnosis of diseases

3. Treatment of brain abscess

4. Surgical treatment of brain abscess

5. medication abscess brain

abscess of the brain called the localized accumulation of pus in the cranial cavity.

There are three types of abscesses:

  • with accumulation of pus in the brain tissue of intracerebral abscess diagnosed;
  • subdural abscess leads to the formation of purulent accumulations under the dura;
  • with epidural abscess pus is localized on the dura.

The cause of this disease is an infection that can penetrate into the cavity of the skull in the following ways:

  • penetrating through the open head injury;
  • hematogenous route;
  • wound infection after neurosurgical intervention conducted;
  • due to chronic inflammatory processes occurring in the middle or inner ear, in the paranasal sinuses.

often Abscesses Brain hematogenous type formed just because of inflammation in the lungs, in particular, due to a chronic pneumo

nia, lung abscess, bronchiectasis, empyema and so forth.

Etiology and pathogenesis

main agents of abscesses hematogenoustypes are streptococci, sometimes in conjunction with bacteroids.As Otogenic and hematogenous abscesses can be caused by Enterobacteriaceae.

For all possible immune-deficient states sowing pus abscess of the brain shows the presence of Aspergillus fumigatus.And with an open head injury, major pathogens are Staphylococcus abscess formation.

It is worth noting that in most cases it is practically impossible to identify the pathogen in pyogenic brain abscess formations.About 30% of all the contents of the abscess crops are sterile.

There are four stages of brain abscess:

- during the first three days is the development of a limited inflammation of the brain tissue, called encephalitis or early tserebritom.At this stage, the inflammatory process is reversible, it may be stopped spontaneously or under the action of antimicrobial therapy.

- on 4-9 th day, when the body's defense mechanisms are no longer cope with the situation, and the first phase of development of an abscess chosen the wrong treatment, the inflammatory process progresses.Purulent education increased.

- 10-13 day purulent focus prolonged protective capsule of connective tissue, this prevents the further spread of purulent process.

- in the third week there is the final sealing of the capsule, around the area formed gliosis.How the process will proceed after that depends on the correct tactics of treatment measures, the virulence of the flora and of the body's defenses.It is possible to reverse the development of the brain abscess, but in most cases there is an increase in the internal volume of the abscess and the formation of new foci of inflammation around the core of the capsule.

Symptoms and Diagnosis

diseases are currently a clear classification of the pathognomonic symptoms of a brain abscess is not revealed.May exhibit a variety of clinical symptoms from headaches to complex brain symptoms.Manifest and focal symptoms of brain damage, and in some cases comes epileptiform seizure.Observed and meningeal symptoms.It will help in identifying the timely diagnosis of an abscess.

Perform the following diagnosis of a brain abscess:

1. A careful history is determined by the presence of inflammation and neurological symptoms.

2. Computed tomography provides greater accuracy in the diagnosis of brain abscess, but not always detect it in the early stages of development.

3. Magnetic resonance imaging gives you a better chance of determining brain abscess, in particular, and in the early stages of its development.

4. Differential diagnosis.

Other diagnostic techniques provide little information.For example, increased erythrocyte sedimentation rate, leukocytosis, elevated blood levels of C-reactive protein, and fever may be symptoms of a wide variety of inflammatory processes.

Treatment of brain abscess

Depending on the stage of development of an abscess, its size and location can be used as conservative and surgical treatment of brain abscesses.

With a small abscess diameter of 3 cm and encephalitic stage is assigned to conservative treatment, based on empiric antibiotic therapy.Sometimes the abscess to identify the pathogen and accurate verification of the diagnosis can be carried out stereotactic biopsy.

almost entirely surgical intervention is recommended for abscesses causing brain dislocation and increased intracranial pressure.Surgery is carried out and the localization of abscess in the ventricular system.In traumatic brain abscess festering in the presence of a foreign body area uniquely produce surgical treatment.

Refuse surgical treatment of brain abscess when it is placed in the vital structures of the brain and at the critical condition of the patient.

Surgical treatment of abscess of the brain

main method of surgical treatment of brain abscesses is a simple or forced-ottochnoe drainage, which amounts to the setting in the abscess cavity catheter to evacuate the pus.After that, the patient is administered antibiotics.After the first installation of the second possible drainage catheter, which is inserted through a solution of 0.9% sodium chloride solution for washing.

less effective but safer method of stereotactic aspiration is the content of an abscess, which does not require the installation of drainage.This is an alternative method of surgical treatment of brain abscess.It is worth noting that in 70% of cases of this method has to be repeated aspiration.

When subdural brain abscess, or in the case of empyema spend drainage and refuse to supply and ottochnoy system.

Drug treatment of brain abscess

In cases where there is no way to determine the causative agent of cerebral abscess, antibiotic treatment is carried out to cover the maximum possible range of causative agents.

When not conduct surgery, prescribe the following treatment of brain abscess:

  • Vancomycin;
  • 3rd generation cephalosporins, namely ceftriaxone, cefotaxime or cefixime;
  • Metronidazole.

If brain abscess developed on the background of open craniocerebral trauma, Metronidazole is prescribed instead of rifampicin.

In patients with immune-deficiency states (excluding HIV), the causative agent of the brain abscess is usually Cryptococcus neoformans, in rare cases, Aspergillus spp and Candida spp.In such situations prescribed Amphotericin B or liposomal amphotericin B. If you went back development of an abscess, the prescribed fluconazole for 10 weeks.

Patients with HIV brain abscess is most often caused by Toxoplasma gondii.To suppress this pathogen is carried out empirical treatment with sulfadiazine and pyrimethamine.


This article is available exclusively in the educational purposes and is not research material or professional medical advice.

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