ABSCESSES OF THE BRAIN

ABCESSES OF THE BRAIN - encapsulated accumulation of pus in the substance of the brain; Can occur through the contact spread of infection (with purulent otitis, osteomyelitis, mastoiditis, sinusitis), hematogenous metastasis from a distant source (lung, mouth, skin, bones, rectum, heart) or as a result of direct infection (with head injury or Neurosurgical intervention). In children, more than 60% of brain abscesses are associated with congenital heart defects, accompanied by a discharge of blood from right to left.

The causative agent is more often streptococci, less often bacteroides, enterobacteria, staphylococcus, fungi, in patients with low immunity - toxoplasm, nocardia, cryptococci, listeria. Predisposing factors are diseases that reduce immunity: diabetes , malignant diseases (including leukemia , lymphoma), AIDS, immunosuppressive therapy, chronic liver and kidney diseases. More often, people of young age.

For a cerebral abscess, a triad of symptoms is characteristic, including headache, fever, focal neurologic symptoms (eg, hemiparesis, aphasia or hemianopsia). However, in its entirety, the triad does not occur in all patients. Thus, an increase in body temperature is noted only in half of the cases, usually before the formation of the capsule of the abscess. After the formation of the capsule (usually by the end of the second week), the common infectious manifestations decrease. Less than half of the patients have meningeal symptoms, epileptic seizures, depression of consciousness, stagnant discs of the optic nerves.

The diagnosis is confirmed by computer and magnetic resonance imaging. The displacement of the midline structures of the brain can be detected using echoencephaloscopy. Lumbar puncture if suspected of brain abscess is contraindicated. To identify the source of infection, X-rays of the skull and thorax, echocardiography, ultrasound examination of the abdominal cavity organs, bacteriological examination of the blood are carried out.

Treatment is surgical. Necessarily the appointment of antibacterial agents. Usually a combination of cephalosporin of the third generation (ceftriaxone or cefotaxime) with antibiotic acting on staphylococci (for example, vancomycin or oxycillin) and antibacterial agent acting on anaerobic bacteria (metronidazole) is usually used. At an early stage of the abscess, or with small (up to 3 cm), multiple abscesses (for example, in the brainstem), antibacterial therapy may be the only method of treatment.