BRAIN ABSCESS

Brain Abscesses are pretty much exclusive to (a) the immunocompromised, (b) those who’ve had brain surgery and (c) kids with ENT infections that were never treated (like a bad case of otitis media).

Symptoms?

The classic triad for a brain abscess is increased intracranial pressure due to a space-occupying lesion (headache, vomiting, confusion, coma), infection (fever, fatigue etc.) and a focal neurologic deficit from dead brain tissue (weakness, aphasia, etc.).

Pathophys of a single abscess?

Local spread. Sinusitis can spread into the frontal lobe. Otitis media can spread to the mastoid air cells (mastoiditis), then to the temporal lobe. And any neurosurgical site is susceptible to becoming infected. 

Pathophys of multiple abscesses?

In cases where there are multiple abscesses, the infection probably spread through the blood. Endocarditis can spew septic emboli all over the brain. The Pork Tapeworm (Taenia solia) can lay egg-like cysts all over the brain (neurocysticercosis). Not common in the US. If AIDS, then consider toxoplasmosis. Toxoplasmosis lesions are ring-enhancing and can be seen on MRI (if someone with AIDS has a single ring enhancing lesion, consider CNS lymphoma).

Treatment?

Abscesses need antibiotics (don’t worry about knowing the specific regiments) and surgical drainage.