Brain Abscess it's causes and treatment and sign symptoms

It best care of brain abscess client

1. Intracranial Infections
in Neurosurgical Practice
Brain Abscess
Shair Muhammad Hazara
PhD Public Health (Fellow), MSPH, MSBE
E-mail address: [email protected]

2. Intracranial Infections in
Neurosurgical Practice

3. Bacterial Meningitis

4. Bacterial Meningitis
with cerebral oedema

5. Bacterial Meningitis
with cerebral oedema

6. Bacterial Meningitis
with cerebral oedema

7. Bacterial Meningitis
with cerebral oedema

8. Bacterial Meningitis with suppuration

9. •Brain abscess (or cerebral abscess) is an
abscess caused by inflammation and collection
of infected material within the brain tissue.,
coming from
•local (ear infection, dental abscess, infection
of paranasal sinuses, infection of the mastoid
air cells of the temporal bone, epidural
abscess)
•or remote (lung, heart, kidney etc.) infectious
sources,
Brain Abscess

10. •The infection may also be introduced through
a skull fracture following a head trauma or
surgical procedures.
•Brain abscess is usually associated with
congenital heart disease in young children. It
may occur at any age but is most frequent in
the 3
rd third decade of life.
•Deadly brain abscesses due to infection caused
from tongue piercing have occurred
Brain Abscess

11. Brain Abscess
•Aetiology and Source of infection:
1.Haematogenous spread: from a known septic site or
occult focus (e.g. from dental infection, respiratory
tract infection or endocarditis), usually causes multiple
brain abscesses. This route is commoner in patients
having congenital heart disease with right to left shunt.
2.Direct spread: from an adjacent infected paranasal
sinus, middle ear, or mastoid infection.
3.Post-traumatic: direct inoculation from trauma, or
after surgery.
Note: in 25% of patients, no cause can be identified.

12. Sources of CNS infection

13. Haematogenous Abscess

14. Direct spread

15. Post-traumatic abscess

16. Brain Abscess Pathology
•Brain abscess will pass in four stages:
Early cerebritis: early 1-3 days with
inflammatory cells.
Late cerebritis: days 4-9, with formation of
necrotic core and increasing number of
macrophages and fibroblasts.
Early capsule: days 10-13.
Late capsule (mature capsule): by day 14.

17. Brain Abscess
•The formation of a collagen capsule in a
developing abscess is the single most
important responsible that limits the spread of
infection to the rest of the brain.

18. •Protozoa
–Toxoplasma gondii
–Entamoeba histolytica,
–Trypanosoma cruzi,
–Schistosoma,
–Paragonimus, &
•Helminths
–Taenia solium
Brain Abscess

19. Collagen capsule of brain abscess

20. Collagen capsule of brain abscess

21. Brain Abscess
•Features of raised intracranial pressure.
•Seizures.
•Meningeal irritation.
•Focal neurological signs.
•Systemic features of infection like fever is
present in half of the cases and is usually
of low grade

22. Brain Abscess
•Investigations:
A.Laboratory Investigations
B. Radiological Investigations

23. Brain Abscess
1.White Blood Cells (WBC) count and
Erythrocyte Sedimentation Rate (ESR)
are usually elevated.
2.Measurement of C-reactive protein is
useful in differentiating brain abscess
from tumour as it is elevated in case of
abscess.
3.Lumbar Puncture is contraindicated in
case of brain abscess to avoid fatal brain
herniation.

24. Brain Abscess
CT or MRI is the investigation of choice.
1.CT Brain is performed with and without
contrast.
2.MRI is done with gadolinium enhancement.
• They will show a single (or multiple) space
occupying lesion that is well delineated with
an enhancing wall, with variable surrounding
oedema.

25. Brain Abscess CT without contrast

26. Brain Abscess CT with contrast

27. Brain Abscess MRI

28. Brain Abscess
The differential diagnosis of a single
brain abscess in CT or MRI is a
solitary metastasis or cerebral
infarction.
The differential diagnosis of multiple
brain abscesses is from multiple
metastasis and tuberculoma.

29. Brain Abscess
A.Non-surgical treatment
(medical treatment)
B. Surgical treatment

30. Brain Abscess
This is indicated for an abscess that is less
than 2.5 cm. It includes:
1.Antibiotics: Appropriate antibiotic selection
is based on culture and sensitivity results,
e.g. penicillin-G, trimethoprim-
sulphamethoxazole, and aminoglycoside.
2.Corticosteroids: help to reduce cerebral
oedema.
3.Anticonvulsants Therapy.

31. Brain Abscess
Aspiration versus excision.
1.Multiple abscesses.
2.A deeply seated abscess.
3.A critical location (e.g. motor or
speech area).
4.Poor general condition of the
patient.

32. Stereotactic Aspiration of
Brain Abscess

33. Stereotactic Aspiration of
Brain Abscess
Stereotactic Aspiration of
Brain Abscess

34. Stereotactic Aspiration of
Brain Abscess

35. Multiple Abscesses

36. Multiple Abscesses

37. Deep Seated Abscess

38. Brain Abscess
1.Multilocular abscess.
2.A superficial abscess.
3.The presence of a foreign body.
4.Fungal abscess.
5.Cerebellar Abscesses.
6.Abscesses containing air.
7.Abscesses with CSF leak.

39. Multilocular Abscess

40. Superficial Abscess

41. Foreign Body

42. Cerebellar Abscess

43. Cerebellar Abscess

44. SUBDURAL
EMPYEMA

45. Subdural Empyemas
•Source of infection:
• Although uncommon, may develop following
sinusitis or mastoiditis.
•It carries a high mortality (5-10 %)

46. Subdural Empyemas
•Clinical picture:
1.Headache, fever and meningism.
2.Seizures are common.
3.Focal neurological deficits which may
progress rapidly to:
4.Altered mental state and coma.
• NOTE: The combination of fever and seizures
with background of sinusitis is usually
diagnostic of this lesion.

47. Subdural Empyemas
•
Despite subdural empyema is a neurosurgical
emergency, diagnosis is often delayed as the
collection on CT is usually so slight and
frequently missed.

48. Subdural Empyemas

49. Subdural Empyemas
•Treatment:
1.Craniotomy and thorough drainage
of the pus, followed by:
2.Intravenous antibiotic.
3.Anticonvulsants.

50. Subdural Empyemas
1.Refractory status epilepticus.
2.Cortical vein/ venous sinus
thrombosis.

51. Nursing interventions
•Nursing interventions are similar to those
for management of meningitis or
increased ICP.
•If surgical removal is the treatment of
choice, nursing interventions are similar
to those described under intracranial
tumors.

52. Intracranial Tumor

53. What its all about….
•Intracranial tumors
include both benign and
metastatic lesions
•All areas and structures
of the brain can be
affected.
•Primary intracranial
tumors, or neoplasms,
arise from the cells of
brain tissue and the
primary and pineal
glands.
•These tumors include
gliomas, mengiomas,
pituitary tumors, and
neuromas.
•Metastatic tumors also
occur frequently in yhe
brain
•Brain tumors are named
for the tissues from
which they arise.

54. subjective data
ØPatients understanding
of the diagnosis
ØChanges in personality
ØPresence of abnormal
sensations or visual
problems.
ØComplaints of unusual
odors may be present
with tumors of the
temporal lobe
objective data
ØMotor strength s, gait,
the level of alertness
and consciousness, and
orientation.
ØThe pupils are assessed
for response and
equality.
ØThe presence of
seizures in an adult is
significant.
ØSpeech abnormalities,
and signs of ICP.

55. Nursing interventions
Preoperative
üPreparation of patient and
the family
üBase line neurological
assessment
üExplaining treatment and
procedures (eg. shaving of
hair)
üHair is shaved in operating
room and may be saved
for pt to make wig.
üFamily needs to be
prepared for the
appearance of the pt after
surgery
Postoperative
üCare is determined by the
pt’s condition.
üMost pts spend one or two
nights in ICU under close
nursing observation with
frequent neurological
checks
üAssess carefully for
indications of increased
ICP
üMonitor pts residual motor
and sensory problems as a
result of the tumor or
surgery.