BRAIN ABSCESS

advertisement
Dr. Amanj Burhan
specialist Neurosurgeon
4/13/2015
Brain Abscess
1
•
•
•
•
•
•
•
•
INCIDENCE:
ETIOLOGY
MICROBIOLOGY
PATHOGENESIS
CLINICAL PRESENTATION
DIAGNOSIS
MANAGEMENT
OUTCOME
4/13/2015
Brain Abscess
2
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 .
4/13/2015
Brain Abscess
3
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)
4/13/2015
Brain Abscess
4
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
4/13/2015
Brain Abscess
5
3. Penetrating trauma :
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 ?
4/13/2015
Brain Abscess
6
B. Basal skull fracture with CSF leak and
meningitis cause post traumatic abscess
• Brain abscess from penetrating trauma is
preventable or not?
4/13/2015
Brain Abscess
7
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
4/13/2015
Brain Abscess
8
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%
4/13/2015
Brain Abscess
9
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
4/13/2015
Brain Abscess
10
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 )
4/13/2015
Brain Abscess
11
4/13/2015
Brain Abscess
12
4/13/2015
Brain Abscess
13
4/13/2015
Brain Abscess
14
4/13/2015
Brain Abscess
15
4/13/2015
Brain Abscess
16
• 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 :
1. Edema
2. Cerebral tissue destruction
4/13/2015
Brain Abscess
17
• 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
4/13/2015
Brain Abscess
18
Laboratory findings
1. WBC : normal or mild increase
2. ESR : increase in 90%
3. CSF : not specific
1.
2.
3.
4.
4/13/2015
Opening pressure
Protein
Glucose
Culture
Brain Abscess
19
4. radiological characteristic of brain abscess
1. Brain CTS with contrast
•
•
•
•
4/13/2015
ring enhancement
Multi loculation
Multiplicity
Finding of gas
Brain Abscess
20
• MRI :
• T1 :
• necrotic center ( hypointence)
• Capsule ( hyperintence)
• Edema ( hypointence)
• T2 :
• necrotic center ( hyperintence)
• Capsule ( hypointence)
• Edema ( hyperintence
4/13/2015
Brain Abscess
21
Management
1. Antibiotic therapy :
• Antibiotic is mandatory and should given
• Antibiotics depends on C/S
• Imperial treatment depend on the etiology
–
–
–
–
4/13/2015
Sinusitis : ( penicillin + metronidazole )
Otitis : ( penicillin + metronidazole + 3rd generation cephalosporin)
Metastatic abscess :(metronidazole + 3rd generation cephalosporin)
Post traumatic abscess ( vancomycin)
Brain Abscess
22
• Advantage of antibiotic therapy
• Small size
• Deep seated
• Multiple
4/13/2015
Brain Abscess
23
2. Aspiration :
• Advantages :
1. Confirm diagnosis
2. Remove of purulent material
3. Provide environment for antibiotics to work
4. Provide immediate relief of IICP
• Stereotactic guided aspiration
4/13/2015
Brain Abscess
24
4/13/2015
Brain Abscess
25
3.Excision of brain abscess
• Advantages
1. Traumatic abscess ( contain foreign body and bone fragment )
2. Fungal abscess
3. Gas containing abscess
• Disadvantages
4/13/2015
Brain Abscess
26
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
4/13/2015
Brain Abscess
27
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)
4/13/2015
Brain Abscess
28
1. Long term morbidity : ( seizure , FND,
Cognitive dysfunction)
2. Recurrence: ( 5-10%) causes ( inadequate
antibiotic therapy, incorrect choice of AB,
presence of foreign body , failure to eradicate
source of the abscess)
4/13/2015
Brain Abscess
29
4/13/2015
Brain Abscess
30
Download
Related flashcards

Protozoal diseases

20 cards

Viral diseases

35 cards

Zoonoses

42 cards

Tuberculosis

33 cards

Neglected diseases

37 cards

Create Flashcards