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  • Cerebral abscess

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  • 324.0 Intracranial abscess

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  • G06.0 Intracranial abscess and granuloma
  • G06.2 Extradural and subdural abscess, unspecified

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

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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, 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 ateriovenous malformation
  • Surgical trauma
  • Cranial injury

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Differential Diagnosis

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  • Stroke
  • Brain tumor
  • Subdural empyema

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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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  • Blood protein moderately elevated
  • Elevated sedimentation rate
  • Moderately increased cerebrospinal fluid (CSF) pressure

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Medication

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  • Antibiotics, usually intravenous, for several weeks
  • Intravenous Mannitol or dexamethasone to prevent cerebellar herniation and temporal-lobe damage

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  • To emergency room physician if emergency identified
  • To neurologist or neurosurgeon for diagnosis and treatment of infection
  • To neuropsychologist for cognitive testing after resolution of the active infection
  • To physiatrist for specific rehabilitation if residual neurologic deficit requires rehabilitation
  • To occupational therapist for ADL, cognitive, and fine-motor task retraining
  • To speech/language pathologist for speech, cognition, and swallowing impairments
  • To respiratory therapist as ...

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