Brain abscess - Overview – Introduction

A brain abscess is an infection in the brain that is encapsulated (confined within its own area) and localized to one or more areas inside of the brain. This condition may cause problems with the brain and spinal cord function. Brain abscesses can occur in all children, but are more common in young school-aged children and occur twice as often in males than in females.

Causes

Brain abscesses commonly occur when bacteria or fungi infect part of the brain. Inflammation develops in response. Infected brain cells, white blood cells, and live and dead microorganisms collect in a limited area of the brain. This area becomes enclosed by a membrane that forms around it and creates a mass.

While this immune response can protect the brain by isolating the infection, it can also do more harm than good. The brain swells and the mass may put pressure on delicate brain tissue. Infected material can block the blood vessels of the brain.

The bacteria or fungi that cause a brain abscess common reach the brain through the blood. The source of the infectious organism is often not found. When identified, the most common source is a lung infection. Bacteria or fungi may also travel from a nearby infected area or be introduced into the body during an injury (such as a gun or knife wound) or surgery.

In children with congenital heart disease or defect, such as those born with Tetralogy of Fallot, infections are more able to reach the brain from the intestines, teeth, or other body areas.

The following raise your risk of a brain abscess:

•    Right-to-left heart shunts
•    Chronic disease, such as cancer or Osler-Weber-Rendu syndrome
•    A weakened immune system (such as those seen in AIDS patients
•    Immunosuppressants (corticosteroids)

Symptoms   

Symptoms may develop slowly, over a period of 2 weeks, or they may develop suddenly. They may include:

•    Headache
•    Stiff neck, shoulders, or back
•    Aching of neck, shoulders, or back
•    Vomiting
•    Changes in mental status
o    Drowsiness
o    Confusion
o    Inattention
o    Irritability
o    Slow thought processes
o    Decreasing responsiveness
o    Eventual coma
•    Seizures
•    Fever and chills
•    Vision changes
•    Loss of muscle function
•    Decreased sensation
•    Decreased movement
•    Weakness
•    Decreased speech (aphasia)
•    Other language difficulties
•    Loss of coordination

Treatment

The treatment includes lowering the increased intracranial pressure and starting intravenous antibiotics.

Surgical drainage of the abscess remains part of the standard management of bacterial brain abscesses. The location and treatment of the primary lesion also crucial, as is the removal of any foreign material (bone, dirt, bullets, and so forth).

There are a few exceptions to this rule: Haemophilus influenzae meningitis is often associated with subdural effusions that are mistaken for subdural empyemas. These effusions resolve with antibiotics and require no surgical treatment. Tuberculosis can produce brain abscesses that look identical to bacterial abscesses on CT imaging and surgical drainage or aspiration is often necessary to make the diagnosis, but once the diagnosis is made no further surgical intervention is necessary.

Prevention   

The risk of developing a brain abscess may be reduced by treating any disorders that can cause them. Such treatment should include a follow-up examination after infections are treated.

Some people, including those with certain heart disorders, may receive antibiotics before dental or urological procedures to help reduce the risk.

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