Brain abscess

Abscess of a brain is accumulation of pus in a skull of the person. The disease has limited character.

Types of abscesses of a brain

Abscesses of a brain happen three types:

• intracerebral (accumulate in the form of pus in marrow);
• epidural (are located over a firm cover of a brain);
• subdural (are localized under a firm cover of a brain).

Origins of abscesses of a brain

The infection gets into a skull the next ways:

• through a wound during neurosurgical intervention;
• through an open craniocereberal injury;
• gematogenno;
• through pyoinflammatory processes on average and inner ear, adnexal nasal bosoms.

Those brain abscesses which form after neurosurgical intervention in time of meningitis and вентрикул arise because of complications of intracranial and infectious character. Generally they appear only at people with extremely weakened immunity.

At an open craniocereberal injury of the getting character abscesses develop because of hit in an infection skull. Very often these abscesses are observed at the people who are involved in fighting because of the gunshot wounds or wounds caused by explosions min.

Hematogenous abscesses of a brain arise because of a bronchoectatic disease, abscesses of a lung, chronic pneumonia, an empyema of a pleura or other pulmonary inflammatory processes. Sometimes developing of abscess is also promoted by infections in digestive tract, sepsis, a bacterial endocarditis of acute or chronic character. The infection gets on a circulatory bed from a vessel in the inflammatory center to brain vessels where it is fixed in a capillary, a precapillary or an arteriole and leads to development of abscess.

If there are sinusitis and pyoinflammatory processes in an inner or middle ear, then the infection can extend in two ways: to get directly through a firm meninx or on sine of a firm cover and veins of a brain. The second way call retrograde, and in the first case the inflammation at first arises in brain covers but only then passes into adjacent department of a brain.

Clinic

The clinic of abscesses of a brain is very similar to clinic of volume educations which symptoms begin with a headache and come to an end with the hardest all-brain symptoms during which consciousness is oppressed and the brain is surprised. The symptomatology accrues progrediyentno. At initial stages of a disease there can be an epileptiform attack. At subdural processes and an empyema meningeal symptoms are observed, and epidural abscesses in a brain on a clinical picture are very similar to osteomyelitis of cranial bones.

Pathogeny and etiology

Brain abscess in four stages forms:

• 1 stage lasts from 1 day to 3 days. There is a development of encephalitis (a limited inflammation of tissues of brain). At this stage to cope with an inflammation it is quite real. It can be resolved as thanks to antibacterial therapy, and is spontaneous.
• 2 stage last from 4 to 9 days. In the center of abscess there is a cavity with pus which increases if abscess not enough protective mechanisms are wrong to treat or in an organism.
• 3 stage last from 10 to 13 days. These days around the center with pus the protective capsule which consists of connecting fabric is formed. This capsule does not allow to extend to purulent process.
• 4 stage are the 3rd week. To this term the capsule was finally condensed and around it the gliosis zone was created. The further situation depends on reactivity of an organism, virulence of flora and efficiency of treatment. At this stage inflammation involution is still possible, but often it only increases and the new centers of an inflammation around the protective capsule appear.

Activators most often are streptococci, sometimes also with accession of bakteriotid (Bacteroides spp.). Otogenic and hematogenous abscesses of a brain cause Enterobacteriaceae. If the open craniocereberal injury of the getting character is an origin of abscess, then find staphylococcus (St. Aureus) and, sometimes, Enterobacteriaceae. After immunodepressive therapies (transplantation of fabrics and bodies), and also at HIV infection in abscess find Aspergillus fumigatus. But it is quite frequent (in 25-30% of cases) it is impossible to define the activator as crops are sterile.

Treatment of abscesses of a brain

Depending on localization, the sizes and a stage of development treatment of abscesses of a brain can be conservative and surgical.

Up to two weeks, and also at small abscesses (to 3 cm) treatment often conservative is also made by means of empirical antibacterial therapy. The stereotaxic biopsy can be also applied to final treatment.

If because of abscesses dislocation of a brain is caused, intracranial pressure increases or they are in a zone of ventricular system that often has a lethal outcome, treatment is made only by means of surgical intervention. Treatment of abscesses of a brain of fungal character also is surgical.

If abscesses are located in the vital and deep brain structures (in a brainstem, a visual bugor or subcrustal kernels) surgical intervention is contraindicated. In such situations apply stereotaxic treatment: puncture of brain abscess. Further the cavity is washed out and administer the antibacterial drugs. Can wash out once or repeatedly (by means of the catheter established for several days).

Surgical treatment of abscesses of a brain is absolutely forbidden if the patient is in critical condition (in a terminal coma).

Prevention of a disease

Prevention of developing of abscesses in a brain is high-quality and timely treatment of inflammatory processes at initial stages. Prevention of emergence of abscess at a craniocereberal injury is full preprocessing of a wound.