ABSCESS
THE DEFINITION;
• Collection of
pyogen material that is wrapped by a capsule, which is located in the parenchim
the brain
• Abscesses occur
when pyogen cerebri bacteria reach the CNS as a direct invasion of otitis
media, mastoiditis, the nasal sinusitis. An abscess is a rare complication
cerebri of pyogen meningitis.
THE ETIOLOGY
The evolution of
the abscess cerebri;
1. Cerebritis, is
an infection that revolve around the white matter oedema.
2. core
cerebritis became enlarged and necrosis, capsul fibroblasts begin to form.
3. the capsule
being formed perfect, with the proliferation of fibroblast proliferation,
surrounded astrocyt and edema.
4. abscess
becomes ripe, thick capsule around the cavum central containing debris and PMN.
The time it takes
14 days
CLINICAL
OVERVIEW
• More common are
at the frontoparietal and temporal, about 13% with abscesses that multiple.
• The most common
Symptoms are fever, headache, coma and focal neurological deficit marks, but
may also be without signs of infection but with signs of the presence of a
tumor.
• may also be
occurring seizures, SIADH, fontanella convex and enlarged head circumference in
children
COMPLICATIONS
-Herniation
-Seizures
-rupture of an abscess
on the sub arachnoid space and ventricle → Meningitis.
DIFFERENTIAL
DIAGNOSES
• intra cranial
tumors
• meningitis
• Chronic SDH
• sub dural
empiyema
• infarction
cerebri
• Tuberkuloma
• Sub acute
Stroke
• Radiation
Necrosis ok
•
Encephalomalacia
• Disseminated
encephalomyelitis
• Herpes
encephalitis
DIAGNOSTIC PROCEDURES
• Signs of infection
• LP to be avoided
• MRI:
Hipointense areas surrounded by hiperintense on T2 or FLAIR
-Informs the contras enhancement
• CT Scanà ring hipodense area with contrast enhancement
• Culture bacteri feature of abscess
PICTURE OF AN ABSCESS ON MRI
(ROOS, 2010)
THERAPY
• Antibiotics administered for 4-6 weeks
• Evaluation of imaging to look at the size of abscess
• Surgery may be either biopsy or excision abscess
• Corticosteroids may inhibit the absorption of antibiotics and formation of capsule
• The mortality rate 40%
|
Infection Source
|
Causative Organism
|
Antibiotic
|
|
Ear, mastoid, Sinus
|
Anaerobes,b Pseudomonas aeruginosa, Streptococcal Sp,
enterobacteriaceae
|
Metronidazole 7.5 mg/kg iv every 6 hours
Plus
Cefepime 2 g iv every 6 hours or meropenem 2 g iv every 8 hours
|
|
Lungs
|
S Pneumonia
|
Same as above
|
|
Teeth, mouth
|
Streptokokkus anaerob, Eikenella dan Prevotella
|
Metronidazole 7.5 mg/kg every 12 hours
Plus
Pennicillin G 4 million units iv every 4 hours or ceftrizoxime 3 g iv every 6 hours
|
|
Postoperative, decubitus, atau furuncel
|
Staphylococcus aureus
S epidermidis,
|
Cefepime 2 g every 8 hours or oxacilline nafcillin or 2 g every 4 hours
|
|
MRSA
|
Linezolid 600 mg iv every 12 hours
|
