ABCESUL CEREBRAL

Cauze :

Copil – meningita

- Otita cronica
- Sinuzita boala cardiac congenitala
- Infectie a suntului (hidrocefalie)

Nou nascut - meningita

period are uncommon and usually occur in children with hydrocephalus and shunt infection. The organisms most
often responsible are Staphylococcus species. After 5 months of age, the infecting organisms are diverse, and
many abscesses contain a mixed flora. Coagulase-positive S. aureus and anaerobic Streptococcus are the
organisms most frequently recovered. Clinical Features. The clinical features of brain abscess, similar to those of
any other space-occupying lesion, depend on the age of the child and the location of the mass. A period of
cerebritis, characterized by fever, headache, and lethargy, precedes encapsulation of the abscess. Seizures also
may occur, but, in the absence of seizures, the initial symptoms may not be severe enough to arouse suspicion of
cerebral infection. If the period of cerebritis is not recognized, the initial clinical manifestations are the same as
those of other mass lesions. Infants have abnormal head growth, a bulging fontanelle, failure to thrive, and
sometimes seizures. Older children show signs of increased intracranial pressure and focal neurological
dysfunction. Fever is present in only 60 % of cases, and meningeal irritation is relatively uncommon. Based on
clinical features alone, pyogenic brain abscess is difficult to separate from other mass lesions, such as brain
tumor. About 80 % of abscesses are in the cerebral hemispheres. Hemiparesis, hemianopia, and seizures are the
usual clinical features. Cerebellar abscess most often results from chronic otitis and is manifest as nystagmus and
ataxia.

Diagnosis. The combination of headache and papilledema, with or without focal neurological dysfunction,
suggests the possibility of a mass lesion and calls for neuroimaging. Most abscesses appear on CT as an area of
decreased density surrounded by a rim of intense enhancement referred to as a ring lesion. This lesion, although
characteristic, is not diagnostic. Malignant brain tumors may have a similar appearance. Ring enhancement
occurs during the late stages of cerebritis, just before capsule formation. After the capsule forms, the diameter of
the ring decreases and the center becomes more hypodense. Multiple abscesses may be present.
Management. The development of neuroimaging has altered the management of cerebral abscess. Previously,
surgical drainage was immediate on diagnosis of abscess formation. Antimicrobials are the initial therapy now
even for encapsulated abscesses, with progress followed with serial scans.

The initial step in treatment is to reduce brain swelling by the use of corticosteroids. Follow the steroids with an
intravenous antimicrobial regimen that generally includes a penicillinase-resistant penicillin, such as methicillin,
300 mg/kg/ day, and chloramphenicol, 100 mg/kg/day. This combination is effective against Staphylococcus and
mixed Gram-negative organisms. Identification of a specific organism by culture of CSF or blood allows specific
antimicrobial therapy. In general, penicillin G is preferable to ampicillin for penicillin-sensitive organisms. If
medical therapy does not resolve the abscess, surgical drainage is necessary. Even in such cases, prolonged
medical therapy before surgery increases the success of total excision.