Brain abscess
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Transcript of 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
Thank youThank you