Brain abscess - a collection of pus in the human skull. The disease has been limited.
Types of brain abscesses
brain are of three types:
- intracerebral (in the form of pus accumulated in the medulla);
- epidural (located above the hard shell of the brain);
- subdural (localized under the hard shell of the brain).
Causes of brain abscesses
It penetrates into the skull of the infection in the following ways:
- through injury during neurosurgery;
- through an open head injury;
- through inflammatory processes in the middle and inner ear, the paranasal sinuses.
Those brain abscesses, which are formed after neurosurgical intervention during meningitis and ventricular arise due to complications, intracranial infectious nature. In general, they appear only in people with very weak immune systems.
When you open traumatic brain injury penetrating nature abscesses develop because of contact with the skull of infection. Very often, these abscesses are observed in the people involved in the fighting, because of gunshot wounds or wounds caused by mine explosions.
Hematogenous brain abscesses occur due to bronchiectasis, lung abscess, chronic pneumonia, pleural empyema or other lung inflammation. Sometimes abscesses also promote infection in the gastrointestinal tract, septicemia, bacterial endocarditis, acute or chronic nature. The infection enters the bloodstream of from vessel to inflammatory lesions in the blood vessels of the brain, where it is fixed in the capillary, precapillaries or arterioles and leads to the development of an abscess.
If you have sinusitis and purulent inflammation of the inner or middle ear, the infection can spread in two ways: directly penetrate through the dura mater, or dura mater sinuses and veins of the brain. The second method is called retrograde, and in the first case the inflammation occurs first in the meninges but only then passes into the adjacent part of the brain.
Clinic brain abscesses is very similar to the clinic space-occupying lesions, symptoms begin with headaches and cerebral symptoms dire end, during which oppressed consciousness and the brain is affected. Symptoms of a progressive growing. In the initial stages of the disease can happen epileptiform seizure. When subdural empyema observed processes and meningeal symptoms, and epidural abscesses in the brain on the clinical picture is very similar to osteomyelitis of the cranial bones.
Pathogenesis and Etiology
Formed brain abscess in four stages:
- Stage 1 lasts from 1 day to 3 days. It is the development of encephalitis (inflammation of the brain tissue limited). At this stage to deal with inflammation is quite real. It can solve both because of antibacterial therapy and spontaneously.
- 2 stage lasts from 4 to 9 days. In the center of the abscess is a cavity with pus, which increases if properly treated or abscess in the body is insufficient protective mechanisms.
- Phase 3 lasts 10 to 13 days. These days, around the hearth with pus form a protective capsule, which consists of connective tissue. This capsule prevents spread of purulent process.
- 4 stage - 3 weeks. By this time capsule is sealed and finally formed around the area gliosis. Further the situation depends on the reactivity of the organism, the virulence of the flora and the effectiveness of treatment. At this point, perhaps even reverse the development of inflammation, but often it is increasing and new foci of inflammation around the protective capsule.
most often streptococci, sometimes also with the accession bakteriotidov (Bacteroides spp.). Otogenic hematogenous and brain abscesses caused Enterobacteriaceae. If the cause of the abscess is an open head injury penetrating character, discover aureus (St. Aureus) and, sometimes, Enterobacteriaceae. After immunosuppressive therapies (transplantation of tissues and organs) as well as HIV-infection in an abscess detect Aspergillus fumigatus. But quite often (in 25-30% of cases) to identify the causative agent is not possible, as the crops are sterile.
Treatment of brain abscesses
Depending on the location, size and stage of development of the treatment of brain abscesses can be conservative and surgical.
Up to two weeks, and at small abscesses (3 cm) and conservative treatment often performed using empiric antibiotic therapy. For the final cure can also be used stereotactic biopsy.
If, due to dislocation caused by brain abscesses, or increased intracranial pressure, they are within the ventricular system, which is often the death, treatment is performed only by surgical intervention. Treatment of brain abscesses fungal nature is also surgically.
If the abscess is located in the vital and deep brain structures (brainstem, thalamus and subcortical nuclei) surgery is contraindicated. In such situations, apply the stereotactic treatment: puncture cerebral abscess. Then the cavity was washed and injected antibiotics. Flush can be mono- or polysubstituted (by using the installed catheter for a few days).
It is absolutely forbidden surgical treatment of brain abscesses, if the patient is in critical condition (in a terminal coma).
Prevention of disease
Prevention of abscesses in the brain is a high-quality and timely treatment of inflammatory processes in the early stages. Prevention of an abscess in the brain injury is a complete primary wound treatment.