Abscess of the brain

Abscess of the brain is a focal congestion of pus in the brain substance.

Etiology, pathogenesis. An abscess occurs as a complication of skull injuries, develops as a result of the spread of infection from the abscesses located in close proximity to the brain, or the introduction of infected microemboli from extracranial foci of purulent infection and septicopyemia. In 30% of cases, the brain abscess has an otogenic origin, localizing in the temporal lobe or in the cerebellum. The second most frequent cause of asbestosis is purulent lung disease.

Symptoms, course. The onset of the disease is usually characterized by a pattern of purulent meningoencephalitis: general severe condition, intense headache, vomiting, high fever, meningeal signs (see Meningitis), polynucleous leukocytosis, increased ESR, moderate pleocytosis in cerebrospinal fluid. With a high virulence of the pathogen, melting of the brain tissue occurs and a capsule of the abscess gradually forms around the formed cavity filled with pus. By the time of its full development (after 4-6 weeks), general infectious symptoms usually subside and the patient's condition improves. In the future, gradually increase intracranial hypertension and symptoms of focal brain damage. In half of the cases, stagnant discs of the optic nerves are noted. Cerebrospinal fluid in the encapsulation of the abscess is little or no change. Inflammatory changes in blood are insignificant. The described pseudotumorous stage of an abscess can last from several months to many years. As the abscess increases and the dislocation phenomena worsen, the risk of cerebral hernias increases, with the brain stem is infringed in the incision of the cerebellar nerve or in the large occipital foramen. The possibility of developing intracerebral hernia dictates extreme caution in carrying out lumbar puncture in case of suspicion of brain abscess.

In the differential diagnosis of brain abscess with focal meningoencephalitis or meningitis, the data of echoencephalography (displacement of the median brain structures in the supratentorial abscess) and computed tomography play a decisive role. The latter makes it possible to distinguish an abscess from a brain tumor. A complex problem is the detection of an abscess in patients with chronic inflammation of the middle ear, complicated by mastoiditis and sinustrombosis.

Treatment of cerebral abscess is only surgical in combination with intensive antibiotic therapy.

Forecast. Postoperative lethality - 20-30%. Particularly unfavorable is the prognosis for multiple abscesses, which constitute 10% of all cases of this disease. Partial patients after surgery persist residual symptomatology (hemiparesis, aphasia, ataxia, etc.).