Brain abscess

BRAIN ABSCESS

1. DEEPAK KRISHNA BRAIN ABSCESS

2. Introduction: A brain abscess is a collection of pus enclosed in the brain tissue, caused by a bacterial or fungal infection which occurs in patients whose immune system have been suppressed either through disease or therapy.

3. Definition Brain abscess is defined as purulence and inflammation in one or more localized regions within the brain parenchyma.

4. Etiology Streptococci and staphylococcus aureus are the primary infective organisms.

5. risk factors: Clients with compromised immune system due to HIV or AIDS(Toxoplasmosis gondii ) Cancer and other chronic illnesses Congenital heart disease Major head injury or skull fracture

6. Cont… Meningitis Immunosuppressant drugs, such as those used in chemotherapy Chronic sinus or middle ear infections

7. Pathophysiology It may occur by direct invasion of the brain from intracranial trauma or surgery; by spread of infection from nearby sites, such as the sinuses, ears, and teeth ( paranasal sinus infections, otitis media, dental sepsis); or by spread of infection from other organs (lung abscess, infective endocarditis )

8. Clinical manifestation Fever Headache Neck stiffness Nausea and vomiting Signs of increased ICP may include drowsiness, confusion and seizures. Decreased movement

9. Cont… Decreased sensation Decreased speech (aphasia ) Hemiparesis Ataxia (Loss of coordination) Visual field defects Nystagmus Hallucinations

10. Diagnostic evaluation Neurological examination shows sings of increased intracranial pressure and problems with brain function. Blood cultures Chest x-ray Complete blood count (CBC) Head CT scan Electroencephalogram (EEG) MRI of head

11. Stereotactic Needle biopsy A needle biopsy is usually performed to identify the cause of the infection.

12. Medical management Antimicrobial therapy IV Antibiotics( Eg : combination drug with Pencillin G and metrondizole ). Corticosteroids ( to reduce cerebral edema) Antiseizure drugs eg : phenytoin

13. Surgical management Surgery is needed if: Increased pressure in the brain continues or gets worse The brain abscess does not get smaller after medication The brain abscess contains gas (produced by some types of bacteria) The brain abscess might rupture.

14. Craniotomy ( opening the skull, exposing the brain, and draining the abscess)

15. Needle aspiration guided by CT or MRI scan may be needed for a deep abscess

16. MRI IMAGE BEFORE & AFTER NEEDLE ASPIRATION

17. Complications Brain damage Meningitis that is severe and life threatening Recurrence of infection Seizures

18. Nursing interventions Nursing interventions should support the medical treatment, as do patient teaching activities that address neurosurgical procedures. Frequently assess neurologic status, especially LOC, speech and sensory, motor and cranial nerve functions.

19. Elevate the head of the bed at 30 degree angle. Monitor for signs of increased ICP: decreased LOC, vomiting, abnormal pupil response and depressed respirations.

20. Patients and families need to be advised of neurologic deficits that may remain after treatment. Always provide safety measures.