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BRAIN ABCESS,

SUBDURAL EMPYEMA AND


EXTRADURAL ABCESS

By:M.M.Fathima Asrin

OBJECTIVES
Describe the following aspects of brain
abcess
Etio-pathogenesis
Morphology of brain
Clinical features
Describe the subdural empyema and
extradural abcess

What is brain abscess?


Focal collection of pus
within brain parenchyma

pathogenesis?
Infection:mostly by bacteria
Direct
20-60% of the cases
Focal abscess

Hematogenous
Multiple abscesses
No identifiable sources in 20-40% of the
cases

Primary sources in direct spread and


distribution of abscess

Otitis media

inferior temporal
lobe and cerebellum

Frontal or ethmoid sinuses


frontal lobe

Dental caries
Foreign bodies

frontal lobe

Primary sources of hematogenous


spread

Chronic pulmonary infections


lung abscess and empyema
Skin infection
Intrabdominal and pelvic infection
Bacterial endocarditis
Cyanotic congenital heart disease
most common in children

Morphology?
Discrete lesions with central

liquefactive necrosis
Surrounded by fibrous capsule &
zone of reactive gliosis
Neovascularization around necrosis
with marked tissue oedema

Symptoms?
Headache most common
Neck stiffness
Associated with occipital abscess
Abscess leaks into lateral ventricle

Altered mental status cerebral


edema
Vomiting increased intracranial
pressure

Physical finding?
febrile not very reliable

Focal neurological deficit

days or weeks after

onset of headache
Parietal lobe-hemiparesis
Temporal lobe-dysphasia
Cerebellum-ataxia & nystagmus

Seizure
May be first manifestation of brain abscess

Third or sixth cranial palsy increased intracranial pressure


Papilledema cerebral edema

Tests?
1. WBC : normal or mild increase
2. ESR : increase in 90%
3. CSF : not specific ,LP is contraindicated
due to risk of herniation
4. Brain CT-contrast

ring enhancement lesion


Multi loculation
Multiplicity
Finding of gas

Treatment options?
Antibiotics
Surgical drainage

SUBDURAL EMPYEMA AND


EXTRADURAL ABCESS
Focal collection of pus around dura matter
following infection usually from direct spread
Assoc.with infection of skull, air sinuses , ear
infection surgical procedure
large subdural abcess has tendency to behave
like a mass lesion & may cause thrombophlebitis
in bridging veins that cross subdural space
Abcess in spinal epidural space may cause
spinal cord compression

Presentation
Fever,headache,neck
stiffness,focal neurological
signs,coma
Treatment with antibiotics
plus surgical drainage results
in complete recovery usually

Thank You