BRAIN ABSCESS

A brain abscess is a collection of pus, immune cells, and other material in the brain, usually from a bacterial or fungal infection.
Causes
Brain abscesses commonly occur when bacteria or fungi infect part of the brain.
Swelling and irritation (inflammation) develop in response to this infection Infected brain cells, white blood cells, live and dead bacteria, and
fungi collect in an area of the brain Tissue forms around this area and creates a mass

The brain swells Because the skull cannot expand, the

mass may put pressure on delicate brain tissue. Infected material can block the blood vessels of the brain. The germs that cause a brain abscess
can reach the brain through the blood.
The source of the infection is often not found. However, the most common source is a lung infection. Less often, a heart infection is
the cause. Germs may also travel from a nearby infected area (for example, an ear infection or a tooth abscess) or enter the body during an injury
(such as a gun or knife wound) or neurosurgery.
The following raise your risk of a brain abscess:

A weakened immune system (such as in AIDS patients)

Chronic disease, such as cancer

Drugs that suppress the immune system (corticosteroids or chemotherapy)

Right-to-left heart shunts, usually the result of congenital heart disease

Symptoms
Symptoms may develop slowly, over a period of 2 weeks, or they may develop suddenly. They may include:

Changes in mental status

Confusion

Decreasing responsiveness

Drowsiness

Eventual coma

Inattention

Irritability

Slow thought processes

Decreased movement

Decreased sensation

Decreased speech (aphasia)

Fever and chills

Headache

Language difficulties

Loss of coordination

Loss of muscle function, typically on one side

Seizures

Stiff neck

Vision changes

Vomiting

Exams and Tests

A brain and nervous system (neurological) exam will usually show signs of increased intracranial pressure and problems with brain function.
Tests to diagnose a brain abscess may include:

Blood cultures

Chest x-ray

Complete blood count (CBC)

Head CT scan

Electroencephalogram (EEG)

MRI of head

Testing for the presence of antibodies to organisms such as Toxoplasma gondii and Taenia solium

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

Treatment
A brain abscess is a medical emergency. Pressure inside the skull may become high enough to be life threatening. Need to stay in the
hospital until the condition is stable. Some people may need life support.
Medication, not surgery, is recommended if you have:

Several abscesses (rare)

A small abscess (less than 2 cm)

An abscess deep in the brain

An abscess and meningitis

Shunts in the brain for hydrocephalus (in some cases the shunt may need to be removed temporarily or replaced)

Toxoplasma gondii infection in a person with HIV

Antibiotics will be prescribed. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are most commonly used.
You may be prescribed several different types of antibiotics to make sure treatment works.
Antifungal medications may also be prescribed if the infection is likely caused by a fungus.
Immediate treatment may be needed if an abscess is injuring brain tissue by pressing on it, or there is a large abscess with a large amount of
swelling around that it is raising pressure in the brain.
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 break open (rupture)

Surgery consists of opening the skull, exposing the brain, and draining the abscess. Laboratory tests are often done to examine the fluid. This can
help identify what is causing the infection, so that more appropriate antibiotics or antifungal drugs can be prescribed.
The surgical procedure used depends on the size and depth of the abscess. The entire abscess may be removed (excised) if it is near the surface
and enclosed in a sac.
Needle aspiration guided by CT or MRI scan may be needed for a deep abscess. During this procedure, medications may be injected directly into
the mass.
Certain diuretics and steroids may also be used to reduce swelling of the brain.
Possible Complications

Brain damage

Meningitis that is severe and life threatening

Return (recurrence) of infection

Seizures

Prevention
Reduce the risk of developing a brain abscess by treating any disorders that can cause them. Have a follow-up examination after infections are
treated.
Some people, including those with certain heart disorders, may receive antibiotics before dental or urological procedures to help reduce the risk
of infection.