Brain abscess

Cerebral abscessCerebral abscess• Epidemiology

PathogenesisHistogenesis

MicrobiologyClinical diagnosis

Radiological evaluation Management

Follow-up radiography

Complications Prognosis

EpidemiologyEpidemiology

• Main factor

• Incidence

• Predisposing factor(otitis.sinusitis.OHI.CHD)

• M/F 2-3/1

pathogenesispathogenesis

• Contiguous suppurative

• Hematogenous

• Dural opening

• Immunosuppression

• None

HistogenesisHistogenesis

1. Early cerebritis

2. Late cerebritis

3. Early capsule formation

4. Late capsule formation

MicrobiologyMicrobiology

• Anaerobes %50

• S.aureus %20-30

• Gram negatives

• Others

Clinical diagnosisClinical diagnosis• History• Symptom&sign • -headache• -focal neurological deficits• -seizure• -fever• -meningismus• -papilledema• -suddenly deterioration• LAB test

Radiological evaluationRadiological evaluation

•CT scan

•MRI

managementmanagement• Nonoperative

• Operative• -aspiration

• -excision

nonoperativenonoperative

• Antibiotic• -sinusitis&otitis----aerobe&anaerobic

• Post traumatic----S.aureus&epidermis..VANCOMYCINE

• Newborn---gramnegative(cyterobacter)…

Only AntiBioticOnly AntiBiotic

1- Uncontrolled bleeding diathesis

2- Multiple abscess small than 1.5 CM in a neurologically intact with a clear source of infection.

managementmanagement• Nonoperative

• Operative• -aspiration

• -excision

aspirationaspiration• Deep

• Eloquent

• multiple

ExcisionExcision•Foreign body

•CSF leakage

•Fungal

•Cerebellar abscess

Multiple abscessMultiple abscess

•Size above 2.5 cm

•Size below 2.5cm

Duration of Duration of ABAB

• Nonoperative…6-8 week

• Operative

• -aspiration…4-6 week

• -excision…2-4 week

• AIDS…1 year

Radiological follow-upRadiological follow-up

• CT weekly during treatment.• CT 1 week afterward.• CT 1 mount then bimonthly…

RESOLVED.• CT entity 2-3 w.after treatment. • Mass effect resolved after 3-4 month.• Contrast in CT until 6-9month.

Corticosteroid roleCorticosteroid role

Only in life threatening Only in life threatening conditioncondition

(mass effect)(mass effect)

ComplicationComplication• Herniation

• Rupture to ventricle & SAS

PrognosisPrognosis• The most prognostic factor:• Neurological condition• -mortality…60% in herniation• -coma…89%• -general…0-21%• Neurological sequelae:• 1-focal neurological deficite• 2-cognitive impairment• 3-seizure

Spinal abscessSpinal abscess•Epidural•Subdural•Intramedullary

•54-80% S.aureus•8-15% stereptococcus

•5-8% mix•4% no growth

Spinal epidural abscessSpinal epidural abscess

• Sign&symptom

• Imaging• -radionuclide scan

• -myelography

• -CT

• -MRI

Symptom&signSymptom&sign• Back pain & fever the most common

• Classically

• 1-backache

• 2-root pain

• 3-extremity weakness

• 4-bowel & bladder symptom

• ESR^

Spinal epidural abscessSpinal epidural abscess

• Sign&symptom

• Imaging• -radionuclide scan

• -myelography

• -CT

• -MRI

treatmenttreatment

•Medical

•Surgical

medicalmedical• Very extensive

• Without severe loss of neural function

• Complete paralysis lasting more than 3 days

Spinal abscessSpinal abscess•Epidural•Subdural•Intramedullary

Clinical signs & symptomClinical signs & symptom

• The same as epidural abscess

Spinal abscessSpinal abscess•Epidural•Subdural•Intramedullary

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