Brain Abscess

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Clinical Description

Collection of pus in the brain parenchyma

Causes:

  • Infection: Streptococcus Pneumoniae. Staphylococcus aureus, Haemophilus Influenza B
  • Complication of meningitis, Mastoiditis, and sinusitis
  • Pott’s puffy tumor
  • Cardiac
  • Cyanotic congenital heart disease
  • Infective endocarditis

Clinical FeaturesSIGNS AND SYMPTOMS

  • Persistent fevers
  • Seizures
  • Focal neurological signs
  • Altered level of consciousness

INVESTIGATIONS

  • FBC
  • Blood culture
  • Urgent CT brain

TreatmentPHARMACOLOGICAL

Adults:

  • Ceftriaxone, IV, 2 g 12 hourly Plus
  • Metronidazole, oral, 400 mg 8 hourly or IV, 500 mg 8 hourly.
  • Adjust according to antimicrobial sensitivity after surgical drainage.

Children:

  • Ceftriaxone 100mg/kg IV q24h
  • Metronidazole 7.5mg/kg IV 8 hourly. Adjust according to antimicrobial sensitivity after surgical drainage.
  • Adequate analgesia
  • Treat seizures

NON-PHARMACOLOGICAL

  • Urgent referral to tertiary facility for imaging and neurosurgical intervention
  • Neuro protective measures

Complications 

  • Raised intracranial pressure
  • Seizures
  • Syndrome of Inappropriate ADH Secretion
  • Stroke

REFERRAL

All patients with suspected brain abscess for imaging and neurosurgical intervention

  • All post-op patients for Intensive Medical rehabilitation Services.