Brain abscess

Introduction Intracerebral abscess refers to the formation of purulent encephalitis, chronic granuloma and brain abscess caused by purulent bacterial infection. A small part can also be caused by fungi and protozoa invading brain tissue and causing brain abscess. Brain abscess can occur at any age and is most common in young adults. Once the abscess is formed, it is a space-occupying lesion. There is cerebral edema around the abscess. The mass effect causes the intracranial pressure to increase and the brain tissue to shift. With the development of the disease, if it is not treated in time, the cerebellar incision or the occipital foramen can be caused. Hey, oppression of the brain stem and further increase of intracranial pressure, leading to a sharp deterioration of the condition.

Cause

Causes

1. Brain abscess caused by the spread of adjacent infections: otitis media, mastoiditis, sinusitis, skull osteomyelitis and intracranial sinusitis and other purulent infections can spread directly into the brain, forming a brain abscess. Among them, brain abscess caused by chronic otitis media and mastoiditis is the most common, called otogenic brain abscess, accounting for about 50% to 66% of all brain abscesses. However, due to the timely eradication of many otitis media and mastoiditis in recent years, the proportion of otogenic brain abscess has been significantly reduced.

2. Blood-borne brain abscess: mainly due to the introduction of inflammatory emboli from the arteries of other parts of the body, which can be retrograde through the thoracic cavity, abdominal cavity and pelvic organs such as liver and gallbladder. Infections such as the armpits and the genitourinary system are transferred to the intracranial vein by the veins of the vertebral plexus and the intraspinal veins. Infections in the facial triangle area may also result in intracranial infections by venous return to the brain. The source of infection is various purulent infections of the chest, such as pneumonia, lung abscess, empyema, bronchiectasis and other brain abscesses, called thymus-induced brain abscess.

an examination

1, clinical features: according to the patient's history of primary purulent infection, open history of craniocerebral injury, followed by acute suppurative meningitis, symptoms of cerebral inflammation and localized symptoms, with headache, vomiting or papilledema, should consider the existence of brain abscess .

2, X-ray photos: X-ray film can show the infection of the skull and paranasal sinus, mastoid. Occasionally, the calcified or calcified pineal gland of the abscess wall is displaced to the opposite side. Traumatic brain abscess can be seen in intracranial fragments and metal foreign bodies.

3, ultrasonic examination: the method is simple and painless. On-screen abscess can have a midline wave shift to the contralateral side, and the subventricular abscess can often measure the expansion of the ventricular wave.

4, cerebral angiography: carotid angiography is of great value in the diagnosis of the on-screen abscess. The abscess is judged based on the displacement of the cerebral blood vessels and the absence of blood vessels or small blood vessels in the abscess area.

Differential diagnosis

Differential diagnosis

1, purulent meningitis: high fever, fast pulse, meningeal irritation signs, but no localized neurological signs, cerebrospinal fluid white blood cells and protein increased, brain ultrasound, cerebral angiography and CT scan are normal.

2, epidural or subdural empyema: often combined with brain abscess, rarely occur independently. Cerebral angiography is a non-vascular area on the brain surface. CT has a half-moon-shaped low-density shadow on the brain surface.

3, thrombotic sinus infection: bacterial emboli detached, caused by the spread of venous sinus, manifested as periodic sepsis sepsis, irregular chills, relaxation of heat, rapid pulse, increased peripheral blood granulocytes, but no change in cerebrospinal fluid, Identification by brain ultrasound, cerebral angiography and CT scan.

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