Abscess, brain

• Cerebral abscess

• 324.0 Intracranial abscess

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

• 5C: Impaired motor function and sensory integrity associated with nonprogressive disorders of the central nervous system – congenital origin or acquired in infancy or childhood
• 5D: Impaired motor function and sensory integrity associated with nonprogressive disorders of the central nervous system – acquired in adolescence or adulthood

Description

• Confined area of infection within the cranium

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 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

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 others effectively
• Difficulty with cognitive processing, particularly executive function

Possible Contributing Causes

• 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

Differential Diagnosis

• Stroke
• Brain tumor
• Subdural empyema

Laboratory Tests

• Sedimentation rate
• Cerebrospinal fluid (CSF) pressure
• Mild to moderate pleocytosis
• Complete blood count (CBC)

Imaging

• CT with contrast
• MRI

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

Medication

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

• 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 ...