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Diagnosis and treatment of a brain abscess

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The epidemiology of brain abscesses has changed in recent years regarding the use and development of new vaccines. We tell you how the condition can be treated.

An abscess in any part of the body is something that always creates concern the first time we hear about it, and we don’t know what to do about it. To remove this worry and fear of the unknown, we will tell you what a brain abscess is all about.

General about brain abscesses

A brain abscess is an accumulation of fluid inside the brain. It forms when bacteria from an infection elsewhere in the head, from the bloodstream, or from a wound, reaches the brain.

Fluid usually builds up in the tissue around a brain abscess. As a result, the surrounding brain tissue swells, and intracranial pressure increases. The larger the abscess, the greater the swelling and pressure.

If the brain abscess leaks or ruptures and gets into the cerebrospinal fluid, which flows through the tissues covering the brain and spinal cord, this can cause meningitis. This pathology can alter neurological function due to inflammation and subsequent effects.

The difference between a brain abscess and encephalitis lies in the fact the absence of a fibrous capsule formation. However, epidemiology has changed in recent years regarding the use and creation of new vaccines, such as the vaccine against Haemophilus influenza type B.

Diagnostics for a brain abscess

The doctor performs several different examinations to establish the diagnosis and the etiology in order to assess which treatment is the best to start. Among the technologies available today are the following:

  • General complementary tests: These are usually of little help and nonspecific.
  • Lumbar puncture: This is not recommended when a focal lesion with mass effect is suspected. The results are usually not very specific.
  • Computed Tomography: This has great diagnostic utility, as it allows one to check for possible links to the medical condition and determine treatment according to the corresponding phase. This technique is also effective in following up on the progression of the disease after treatment.
  • Magnetic resonance imaging: This is the best type of imaging study when diagnosing a brain abscess. It is much more sensitive than computed tomography and offers many advantages in the detection of early cerebritis and edema and better differentiation between areas of inflammation and other affected structures.
  • Scintigraphy: This is an examination method where you radioactively mark certain cells. These cells accumulate during inflammation and thus distinguish brain abscess from other possible causes of the condition.
  • SPECT: This method has been shown to be effective in AIDS patients in differentiating between primary cerebral lymphoma and infectious brain lesions.
  • Biopsy.

What does the treatment look like for a brain abscess?

Treatment includes neurosurgery aimed at draining the abscess, as well as drugs to reduce inflammation and the size of the lesion. Antibiotics and corticosteroids are some examples.

Antibiotics

A combination of vancomycin, ceftriaxone, and metronidazole has been shown to be effective. Third-generation cephalosporins and metronidazole have an adequate antimicrobial spectrum and penetration into the central nervous system, which is why they are effective in most infections associated with this condition.

Corticosteroids

The use of these drugs to treat this pathology is controversial, as there are no randomized studies supporting their effectiveness in this setting. Glucocorticoids are administered when there is a vasogenic edema around the abscess, a mass effect, and increased pressure.

This suggests that they could only be used in the acute phase of the disease for the management of endocranial hypertension. However, these drugs can also be effective in controlling postoperative edema in cases where the neurosurgeon recommends this.

A complex condition that requires medical attention

Because of the potential complications that can occur, patients with symptoms consistent with a brain abscess should seek emergency care for specialized evaluation as soon as possible. The earlier you can start treatment, the greater the chances for a good recovery.

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