Brain abcess

An abscess is a pus-filled cavity in the body. In the case of a brain abscess, this cavity is located in the large brain or in the cerebellum. An abscess is a defense by the body that causes infections or invaded objects such as wood splinters to be encapsulated. A membrane is then formed.

On brain scans a clear edge of encapsulation can be seen around the abscess. There may be multiple abscesses. Not to be confused with a brain cyst, which is filled with cerebrospinal fluid (liquor). The content of an abscess consists of live and dead bacteria (or fungi), dead white blood cells, broken tissue cells.

There are three stages in abscess formation and depending on this treatment will be chosen: 1. cerebritis (inflammation of the brain), 2. early capsule formation, 3. late capsule formation.

The bacteria (usually staphylococci and streptococci) or fungi have penetrated the body and the brain through an infection. This can be via an inflammation near the brain (local spread), for example cavity inflammations: a forehead inflammation, a sinus inflammation of the nose or an ear infection. It can also be caused by an epidural abscess or an infection of air cells from the mastoid, (protrusion in the bone, behind the ear). A congenital pathway (a a fistula passage) of the skin to the outside also occurs (rarely).

Inflammation a little further away can also be the cause of a brain abscess: an inflamed set of teeth, tooth or tooth or lung or kidney inflammation (haematogenous spread). But also a congenital heart defect in which a vein directly exchanges blood with arteries, can be the cause. (a connection of the right half of the heart with the left half of the heart).

The infection can also be directly caused by a skull or brain operation or after injury and also occurs when an object enters the brain after skull trauma (penetrating skull trauma).

This article describes a case of a patient in Korea who developed an abscess from a typhoid bacterium.

 

Risk groups

A brain abscess takes up space in the brain. It can pinch brain tissue and cerebral blood vessels. Headache is the most commonly heard complaint. The headache does not pass after taking painkillers. Fever is not always present. Other symptoms include nausea, vomiting, muscle weakness (usually on one side of the body), weakness, reduced sensory perception, seizures, and speech and visual disturbances. The complaints are similar to those of a brain tumor, but blood tests will show increased inflammatory values.

 

Complaints of an abscess in the big brain

• Headache
• Neurological deficits
• Epileptic attacks

 

A brain abscess is treatable. Both the penetrated objects and the pus will have to be removed.

• By antibiotics if the antibiotics can penetrate the capsule.
• By making a hole in the skull and emptying the abscess by sucking out pus and rinsing the cavity. A long-term antibiotic treatment of several weeks per infusion will follow.
• By making a hatch in the skull, opening the abscess through the hard cerebral membrane, leaving a drain and rinsing the cavity. A long-term antibiotic treatment of several weeks per infusion will follow.
• Medication against fungi or against viruses may be necessary if a fungal or viral infection is suspected.
• Medications that counteract the swelling in the brain.
• Any inflammations elsewhere in the body that caused the abscess will have to be addressed.

 

Consequences

Brains are vulnerable. A treatment or a scar can give complaints that may correspond to those of local brain injury. Complaints like epilepsy, overstimulation, decreased capacity and other effects from the list of invisible effects of brain injury can occur.