Brain Abscess

Question 1

Brain abscess

Answer 1

• focal, intracranial infection
• begins as localised area of inflammation
• spreads to collection of pus surrounded by well-vascularised capsule

Question 2

Main causes of brain abscess

Answer 2

• contiguous spread of infection (sinusitis, otitis, dental)
• haematogenous spread (endocarditis, pulmonary infections)
• direct inoculation from trauma or neurosurgery

Question 3

Risk factors for developing brain abscess

Answer 3

• immunocompromised
• congenital heart disease
• chronic otitis/sinusitis
• IV drug use

Question 4

Pathophysiology of brain abscess

Answer 4

1. early cerebritis (days 1-3)
2. later cerebritis (days 4-9)
3. early capsule formation (days 10-13)
4. late capsule formation (> 14 days)

Question 5

Clinical features of brain abscess

Answer 5

Classic triad:
- headache (dull, constant, progressive, localised)
- focal neurological deficits
- fever

Other:
- seizures
- nausea, vomiting
- altered consciousness
- papilloedema

Question 6

Investigating for brain abscess

Answer 6

• CT
• MRI

Question 7

Managing brain abscess’

Answer 7

• surgery: craniotomy and debridement
• IV antibiotics (cephalosporin, metronidazole)
• intracranial pressure management (dexamethasone)