Makindo Medical Notes.com

Related Subjects: |Brain tumour s |Astrocytomas |Brain Metastases

Biopsy often needed to differentiate from tumour

About

• Can be difficult to differentiate from tumour
• Usually Staphylococcus and Streptococcus

The incidence of fungal brain abscesses has also risen because of the increased use of broad-spectrum antibiotics and immunosuppressive agents like steroids

Risks

• Alcoholism, Immunodeficiency
• Skull fracture
• Associated mastoiditis or localised infection
• Dental abscess, bronchiectasis, TB
• AIDS, Endocarditis

Clinical

• Headache (69%-70%) is the most common medical symptom
• Mental status changes could suggest oedema
• Fever, Focal to generalised seizures
• General Malaise, drowsiness, toxic Space occupying lesion
• Headache, focal seizure, neurological signs
• Poor dentition Evidence of neglect/alcoholism
• Rupture of abscess usually presents with a sudden worsening headache
• Followed by emerging signs of meningism.
• Differential is always from a tumour

Investigations

• Elevated CRP, WCC, Blood cultures, HIV serology
• Echocardiogram CXR ? Bronchiectasis, exclude lung tumour
• CT Brain with contrast: Early cerebritis often manifests as an irregular low-density area that does not enhance or may exhibit infrequent patchy enhancement. As cerebritis progresses, a more distinct rim-enhancing lesion becomes visible.
• MRI Brain with gadolinium: is the preferred imaging modality for diagnosing and following lesions due to its heightened sensitivity, particularly for early cerebritis and satellite lesions, particularly those located in the brain stem. Additionally, it facilitates a more accurate estimation of necrosis and the extent of the lesion. MRI allows for greater contrast between cerebral oedema and the brain and is also more sensitive in detecting the spread of inflammation into the ventricles and subarachnoid space
• Lumbar puncture avoided due to risk of coning: Lumbar puncture: Rarely required and should only be performed after a prior head computed tomography (CT) and magnetic resonance imaging (MRI) scan to rule out increased intracranial pressure due to the potential risk of cerebrospinal fluid (CSF) herniation and potential fatality
• Brain Biopsy may be needed for culture and diagnosis: Biopsy through needle aspiration or surgical drainage is typically recommended in most patients to establish the diagnosis and identify the etiologic agent.[

Management

• Stereotactic biopsy and culture may be needed to confirm the diagnosis and identify the organism
• Antibiotics depending on culture and sensitivity
• Anticonvulsants may be needed
• Neurorehabilitation Lesions can be destructive. Low CSF pressure headache