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80: BRAIN ABSCESS

Mollie Venglar, DSc, MSPT, NCS

CONDITION/DISORDER SYNONYM

  • Cerebral abscess

ICD-9-CM CODE

  • 324.0 Intracranial abscess

ICD-10-CM CODES

  • G06.0 Intracranial abscess and granuloma

  • G06.2 Extradural and subdural abscess, unspecified

PREFERRED PRACTICE PATTERNS

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—congenital origin or acquired in infancy or childhood1

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—acquired in adolescence or adulthood2

PATIENT PRESENTATION

A 37-year-old female was brought to the emergency department (ED) when her roommate was unable to arouse her in the morning. The roommate reported that for several days the woman had increasing difficulties with maintaining conversations and managing her normal schedule. For several months she had complained of tooth and jaw pain but had not been to the dentist. In the ED, she continued to be unconscious and her respirations were inadequate to maintain life. She was placed on a ventilator. Brain imaging revealed an abscess in the area of the inferior aspect of left frontal lobe and anterior left temporal lobe.

FIGURE 80-1

Cerebral abscess—common sites and routes of infection. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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KEY FEATURES

Description

  • Confined area of infection within the cranium

  • Cerebral abscess: Common sites of infection3

Essentials of Diagnosis

  • 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

General Considerations

  • Approximately 50% are metastatic

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

Demographics

  • 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.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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)

Functional Implications

  • Loss of independence with all aspects of mobility, ADLs, self-care

  • Impaired ability to interact with ...

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