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Condition/Disorder Synonym

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  • Cerebral abscess

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ICD-9-CM Codes

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  • 324.0 Intracranial abscess

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ICD-10-CM Codes

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  • G06.0 Intracranial abscess and granuloma

  • G06.2 Extradural and subdural abscess, unspecified

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Preferred Practice Patterns

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Key Features

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Description

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  • Confined area of infection within the cranium

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Essentials of Diagnosis

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  • Greater than 90% of brain abscesses due to external causes: Compound fracture of skull, bullet wound, surgical complication involving brain or cranium

  • May be secondary to infectious process elsewhere in the body including the following:

    • - Paranasal sinus (rhinogenic): Usually leads to abscess in frontal and temporal lobes

    • - Middle ear (otogenic): Usually leads to abscess in anterolateral cerebellum, middle and inferior temporal lobe

    • - Pulmonary infection

    • - Bacterial endocarditis

  • Rupture of abscess can advance to irreversible coma

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General Considerations

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  • Approximately 50% are metastatic.

  • Approximately 20% cannot be traced to site of origin.

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Demographics

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  • All ages and genders, who experience one of the contributing causes, are at risk for developing a brain abscess.

  • Approximately 60% of children who develop a brain abscess have congenital heart disease.

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Clinical Findings

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Signs and Symptoms

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  • Headache

  • Drowsiness

  • Confusion

  • Focal or generalized seizure

  • Focal motor, sensory, or speech disturbance

  • Fever (inconsistent)

  • Leukocytosis (inconsistent)

  • Increased intracranial pressure (later in the course of illness)

  • Papilledema (later in the course of illness)

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Functional Implications

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  • Loss of independence with all aspects of mobility, activities of daily living (ADLs), self-care

  • Impaired ability to interact with others effectively

  • Difficulty with cognitive processing, particularly executive function

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Possible Contributing Causes

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  • Bacterial endocarditis

  • Pulmonary infection

  • Sinus infection

  • Middle-ear infection

  • Congenital heart disease

  • Infected pelvic organs

  • Infected tonsils

  • Abscessed teeth

  • Osteomyelitis

  • Pulmonary arteriovenous malformation

  • Surgical trauma

  • Cranial injury

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Differential Diagnosis

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Sedimentation rate

  • Cerebrospinal fluid (CSF) pressure

  • Mild-to-moderate pleocytosis

  • Complete blood count (CBC)

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Imaging

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Findings and Interpretation

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  • Blood protein moderately elevated

  • Elevated sedimentation rate

  • Moderately increased cerebrospinal fluid (CSF) pressure

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Treatment

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Medication

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  • Antibiotics, usually intravenous, for several weeks

  • Intravenous mannitol or dexamethasone to ...

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