Clinical Presentation
Focal mass expansion, Intra-cranial hypertension, Diffuse destruction, Focal neurological deficit
Common presenting signs and symptoms in BA
temporal lobe and cerebellum
solitary BA
Hematogenous spread distribution of the multifocal BA middle cerebral artery
Stages of brain absces巨噬细胞和纤维细胞的炎性增生带 胶原包膜带 新生血管和成纤维细胞炎性增生带 反应性星形胶质细胞增生及脑水肿带
Further advances in： Microorganism isolation and identification, Superior antimicrobials with greater cerebrospinal fluid (CSF) penetration Stereotactic aspiration resulted in a contemporary mortality of less than 10%.
Diagnosis
CT scan with contrast MRI DWI 1H-MRS Lumbar puncture ?
Suggested exploration protocol when a brain abscess is suspected
Management
Team: Neurosurgeon Neurologist Infectious disease specialist, Neuroradiologist.
The cases are usually elder or pediatric male patients. The incidence of BA is 8% of intracranial masses in developing countries and 1-2% in the western countries. Mortality from a BA has recently decreased from about 50% to 20%, mostly as a result of introduction of CT scanning that resulted in earlier diagnosis and accurate localization.
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英文课件
脑脓肿
Brain Abscess
Introduction & History
Hennry II (1519-1559)
Oscar Wilde 1854~1900
Epidemiology
BA is more common among men –twice to three times. Morbidity rate is highest in fourth decade of the life. BA still continues to be a significant problem in the developing world due to large scale poverty, illiteracy, and lack of hygiene.
Mortality is mainly influenced by : Age Neurological condition at admission; Delays in hospitalization, Focal neurologic deficits at admission, Impaired host immunity, Uncontrolled diabetes mellitus, Glasgow Coma Scale (GCS) <12 associated with death and permanent neurologic deficits.
Etiology
Anaerobic pathogens Oral cavity infection Hemathogenous spread (intraabdominal/pelvic) infection, otorhinolaringeal infection Trauma Gram-positive cocci Patients with prior Gram-negative rods neurosurgical procedures Patient with cardiac origin (cyanotic heart disease) and right-to-left shunts Peptostreptococcus and Streptococcus
BA, from where it came?
Spread from pericranial contiguous focus 25-50% sinuses, middle ear, dental Hematogenous spread 15-30% lung abscess or empyema, bacterial endocarditis, skin infections, intra-abdominal (including pelvic) infections Direct inoculation
8-19% head trauma neurosurgery
Dental infections, ethmoid or frontal sinusitis
frontal lobe
solitary BA
Subacute or chronic otitis media or mastoiditis