Where does the infection come from?
Most often, bacteria enter the brain from a nearby purulent focus: the middle ear and mastoid process, paranasal sinuses, teeth and jaw. The second way is transfer with blood from a distant focus, for example, with bronchiectasis, lung abscess, infective endocarditis. A separate group consists of abscesses after open traumatic brain injury and neurosurgical operations. In people with a pronounced decrease in immunity, the pathogens may be fungi and unusual microorganisms, which changes the approach to treatment.
- Chronic purulent otitis and mastoiditis
- Purulent sinusitis
- Odontogenic lesions - caries, periodontitis
- Transfer with blood in diseases of the lungs and heart
- Penetrating cranial trauma
- Complications of operations
- Immunodeficiency
Symptoms
The picture consists of three components. The first is signs of increased intracranial pressure: persistent increasing headache, nausea and vomiting, drowsiness. The second is focal disorders, depending on the location of the abscess: weakness in the limbs, speech impairment, loss of visual fields, unsteadiness. The third is signs of infection: fever, weakness, changes in blood tests. At the same time, not everyone has a temperature, especially if the person has already taken antibiotics, so its absence does not exclude the diagnosis. Seizures occur in approximately every fourth patient.
- Increasing headache
- Nausea and vomiting
- Temperature rise
- Weakness in an arm or leg, difficulty speaking
- Seizures
- Drowsiness and confusion
- Papilledema during fundus examination
Diagnostics
If a volumetric process in the brain is suspected, visualization is immediately performed. Contrast-enhanced computed tomography is available in emergency situations and reveals a lesion with characteristic ring-like enhancement. Magnetic resonance imaging is more accurate, especially in special modes that make it possible to distinguish an abscess from a tumor. Inflammatory parameters are assessed in the laboratory and blood cultures are taken. Be sure to look for the primary focus: examine the ENT organs, teeth, and perform an examination of the heart and lungs. Lumbar puncture for a mass formation is dangerous and should not be performed without the permission of a neurosurgeon.
- CT scan of the brain with contrast
- MRI of the brain with contrast
- Complete blood count and C-reactive protein
- Blood culture
- Examination by an ENT doctor and dentist
- Echocardiography and x-ray of the lungs when searching for the source
- Culture of abscess contents during drainage
Treatment
Treatment is always inpatient and usually combined. Antibiotics are administered intravenously, starting with a broad spectrum and adjusting after cultures are obtained; the course is long, often several weeks. If the abscess is of sufficient size, it is drained by puncture under navigation, which simultaneously provides material for seeding and reduces pressure; less often, open removal along with the capsule is performed. A mandatory stage is sanitation of the primary lesion: surgery on the ear, sinuses or dental treatment, otherwise a relapse is possible. For seizures, anticonvulsants are prescribed, and for cerebral edema, appropriate therapy is prescribed.
- Hospitalization in the neurosurgical department
- Long-term intravenous antibiotic therapy
- Puncture drainage under navigation
- Open removal of abscess in selected cases
- Sanitation of the primary purulent focus
- Anticonvulsant therapy
- Control CT or MRI in dynamics
Prevention and surveillance
The best prevention is timely and complete treatment of purulent diseases of the ear, sinuses and teeth, and not endless courses of drops and rinses. People with chronic otitis media, congenital heart defects and reduced immunity should be especially wary. After an abscess, long-term observation with repeated imaging, continuation of anticonvulsant therapy when prescribed, and rehabilitation to restore lost functions are required. Return to work and driving is discussed with a neurologist.
- Timely treatment of otitis and sinusitis
- Dental sanitation and regular dental examinations
- Observation for heart defects
- Control studies after treatment
- Continue anticonvulsants as prescribed
- Rehabilitation for neurological deficits
- Discussing driving with a doctor