Brain abscess: Difference between revisions
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**Direct implantation by surgery or penetrating trauma (10%) | **Direct implantation by surgery or penetrating trauma (10%) | ||
*Microbiology | *Microbiology | ||
**Streptococci in 50% of cases<ref>Somand D, Meurer W. Central Nervous System Infections. EMCNA 2009; 27: 89-100.</ref> | |||
**Anaerobes and Gram-negative rods are typical pathogens | **Anaerobes and Gram-negative rods are typical pathogens | ||
**Staph is involved with direct implantation cases | **Staph is involved with direct implantation cases | ||
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*Focal neuro symptoms or seizure (~33% of patients) | *Focal neuro symptoms or seizure (~33% of patients) | ||
*Neck stiffness (<50% of patients) | *Neck stiffness (<50% of patients) | ||
*Signs of increased ICP: vomiting, confusion, obtundation (50% of patients) | *Signs of increased ICP: papilledema, vomiting, confusion, obtundation (50% of patients) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 18:51, 19 August 2017
Background
- Caused by one of three methods:
- Hematogenous spread (33%)
- Contiguous infection from middle ear, sinus, teeth (33%)
- Direct implantation by surgery or penetrating trauma (10%)
- Microbiology
- Streptococci in 50% of cases[1]
- Anaerobes and Gram-negative rods are typical pathogens
- Staph is involved with direct implantation cases
Clinical Features
- Patients rarely appear acutely ill
- Classic traid of headache, fever, AND focal neuro deficit is present in <33%
- Headache is most common symptom (present in almost all cases)
- Fever (~50% of patients)
- Focal neuro symptoms or seizure (~33% of patients)
- Neck stiffness (<50% of patients)
- Signs of increased ICP: papilledema, vomiting, confusion, obtundation (50% of patients)
Differential Diagnosis
- CVA
- Meningitis
- Malignancy
Intracranial Mass
- Intracranial hemorrhage
- Intra-axial
- Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
- Traumatic intracerebral hemorrhage
- Extra-axial
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
- Intra-axial
- Brain tumor
- Brain abscess
- Subdural empyema
- Epidural abscess (intracranial)
Evaluation
Workup
- Head CT with contrast
- Blood cultures
Evaluation
- CT with contrast
- Ring enhancing lesion surrounding low-density center surrounded by white matter edema
- Early in course ring may be less defined; CT may only show area of focal hypodensity
Management
Antibiotics
Otogenic source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Sinogenic or odontogenic source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Penetrating trauma or neurosurgical procedures
- Vancomycin 15mg/kg IV q12hr + ceftazidime 2gm IV q8hr
Hematogenous source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
No obvious source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Disposition
- Neurosurgery consultation
References
- ↑ Somand D, Meurer W. Central Nervous System Infections. EMCNA 2009; 27: 89-100.