Before a brain abscess has become encapsulated and localized, antimicrobial therapy, accompanied by measures to control increasing intracranial pressure, is essential. Once an abscess has formed, surgical excision or drainage combined with prolonged antibiotics (usually 4-8 wk) remains the treatment of choice.
Most people need a further 6 to 12 weeks rest at home before they're fit enough to return to work or full-time education. After treatment for a brain abscess, avoid any contact sport where there's a risk of injury to the skull, such as boxing, rugby or football.
Your healthcare provider can treat cerebral abscesses with medicines, including antibiotics or drugs to fight a fungal infection. Your healthcare provider may also give you steroid drugs to lower pressure in your brain, or other drugs to reduce seizures. You may need surgery, especially for larger abscesses.
Antibiotics are the first-line treatment for brain abscess. High-dose, broad-spectrum, intravenous antibiotics should be administered as early as possible in the patient's course. Emergent consultation with neurosurgery is recommended; however, delay in consultation should not delay antibiotic administration.
If left untreated, a brain abscess can cause permanent brain damage and could be fatal. A brain abscess is usually treated using a combination of: medicines – either antibiotics or antifungals.
Unfortunately, long-term neurological problems are common even after the abscess is removed and the infection is treated. For example, there may be lingering problems with body function, personality changes or seizures due to scarring or other damage to the brain.
Antimicrobial treatment for a brain abscess is generally long (6-8 wk) because of the prolonged time needed for brain tissue to repair and close abscess space. The United Kingdom treatment guidelines advocate 4-6 weeks if the abscess has been drained or removed and 6-8 weeks if drainage occurred.
A brain abscess is a collection of pus that develops in response to an infection or trauma. It remains a serious and potentially life-threatening condition.
Brain abscess passes through 4 stages: early cerebritis, late cerebritis, early capsule, and late capsule. During early cerebritis, nonenhanced CT scans may demonstrate normal findings or may show only poorly marginated subcortical hypodense areas.
Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86% cases and recovery with major neuro-deficit was observed in 5.55% cases.
Most common symptoms
Because these can be symptoms of many illnesses, a brain abscess can be hard to detect at first. In two-thirds of cases, people have symptoms for as long as two weeks before they are diagnosed.
Outlook (Prognosis)
If untreated, a brain abscess is almost always deadly. With treatment, the death rate is about 10% to 30%. The earlier treatment is received, the better. Some people may have long-term nervous system problems after a brain abscess or surgery.
In most modern series, the mortality rate is typically less than 15%. Rupture of a brain abscess is uncommon but is associated with a high mortality rate (up to 80%). Significant morbidity, including seizures, persistent weakness, aphasia, or cognitive impairment, affects an estimated at 20-30% of survivors.
What Are the Symptoms of a Brain Abscess? The most common symptoms are fever, headache, and nervous system problems. Such problems may be confusion, disorientation, speech or walking difficulties, change in mental status, or arm and leg weakness on one side.
An infection in your body is considered a threat. If they are not treated, they can last for several months or years. There are two types of dental abscess – one can form under the tooth (periapical) and the other in the supporting gum and bone (periodontal).
Cerebral phaeohyphomycosis (CP) is a very rare but serious form of central nervous system fungal infection that is caused by dematiaceous fungi. It is commonly associated with poor prognosis irrespective of the immune status of the patient.
REFRACTORY INFECTION — Despite incision and drainage and a complete course of antibiotics, abscesses fail to resolve in about 10 percent of patients [10,11]. Failure to improve after incision and drainage and 24 to 48 hours of appropriate antibiotic therapy should prompt assessment for possible reasons for nonresponse.
Unlike other infections, antibiotics alone will not usually cure an abscess. In general an abscess must open and drain in order for it to improve. Sometimes draining occurs on its own, but generally it must be opened with the help of a warm compress or by a doctor in a procedure called incision and drainage (I&D).
If the bacteria causing your infection are not covered under the spectrum of the antibiotic you are prescribed, then the infection will remain. Lastly, antibiotics do not work for fungal or viral infections. Antibiotics carry risks, such as allergic reaction.
Brain abscess is caused by intracranial inflammation with subsequent abscess formation. The most frequent intracranial locations (in descending order of frequency) are frontal-temporal, frontal-parietal, parietal, cerebellar, and occipital lobes.
For example, in the late stage of bacterial infection, the formation of brain abscess shows MRI manifestation as a typical rim-like enhancement, which is often similar to necrotic malignant tumors, especially glioblastoma multiforme (GBM) (8).
CT scan has formed the mainstay in the diagnosis of patients of brain abscess in recent years. It offers a highly accurate, relatively noninvasive and rapid means of establishing the diagnosis and following the course of disease.