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Brain Abscess

Overview
A brain abscess is a bacterial infection that causes accumulation of pus in the brain, and swelling of the organ. This condition usually occurs after bacteria or fungi enter the brain tissue due to head injury or infection in other tissues.

Although rare, a brain abscess is an infectious disease that can endanger life and must be dealt with immediately. Anyone can experience it, but this risk generally increases in people with a history of diseases such as:

  • HIV / AIDS, cancer, and chronic diseases.
  • Infection of the middle ear (otitis media).
  • Sinusitis
  • Congenital heart disease (CHD), such as the tetralogy of fallot (ToF).
  • Meningitis.

In addition, the risk of brain abscess is also quite high in someone who has a severe head injury or skull fracture, has had an organ transplant, is using immunosuppressive drugs, or is undergoing chemotherapy.

Symptoms
Symptoms of brain abscess are usually felt within weeks after infection, or sometimes directly. The following are a series of symptoms that can occur:

  • Great headache.
  • Nausea and vomiting.
  • High fever (above 38 C).
  • Shivering.
  • Behavior changes, such as feeling restless or dazed.
  • The neck feels stiff.
  • Convulsions.
  • Decreased ability to feel sensations, move muscles, or speak.
  • Impaired vision, such as double vision, blurred or blurred.
  • Sensitive to light.

As for some symptoms that can be seen if your baby or child has a brain abscess, including:
  • Gag.
  • Crying in a high tone.
  • Body muscles look stiff.
See a doctor immediately if symptoms continue to be felt, especially for those who experience sudden seizures, speech starts to become unclear, muscles weaken, or paralysis.

Cause
The main cause of brain abscess is the presence of bacterial or fungal infections that enter the brain tissue, because the immune system cannot fight it. Actually the body is equipped with an immune system that functions to maintain important organs. But in certain cases, germs can enter through blood vessels and attack the brain. Infection that enters the brain will accumulate in brain tissue and form lumps of pus.

Certain diseases that can cause brain abscesses are:
  • Cyanotic heart disease. One type of congenital heart disease that results in the heart being unable to drain oxygen throughout the body and trigger infection.
  • Pulmonary arteriovenous fistula. Abnormalities that occur in the pulmonary blood vessels, causing bacteria to enter the blood and flow to the brain.
  • Tooth abscess.
  • These conditions include pulmonary infections (eg pneumonia), heart infections (eg endocarditis), infections in the abdominal cavity (such as peritonitis), pelvic infections (such as cystitis), and skin infections.

Diagnosis
In the early stages of the diagnosis, the doctor will perform a physical examination while analyzing the patient's symptoms and medical history. A follow-up examination will also be carried out to confirm the results of the diagnosis, including:

  • Neurological examination, which includes movement of muscles, nervous system, and sensory.
  • Blood test, to check for certain infections.
  • Scanning, to see the location of inflammation or swelling. Scanning includes X-rays, CT scans, EEGs, or MRIs.
  • Lumbar puncture. Taking samples of cerebrospinal fluid from the spinal cord to check if there are certain bacteria. This action cannot be done if the patient experiences severe brain swelling, because it can make the pressure in the brain worsen.

If the results of the follow-up test cannot identify the cause and source of the infection, the doctor may suggest a biopsy.

Treatment
Brain abscess is an emergency condition and needs to be dealt with immediately. Treatment is usually done in a hospital with antibiotics or antifungal drugs until the patient enters a stable stage. Sometimes, diuretic drugs can also be prescribed. However, if the patient's condition is bad enough, the doctor can recommend surgery.

The following are the criteria for brain abscesses treated with drugs:

  • Abscesses smaller than 2 cm.
  • Abscesses are at some point.
  • Abscesses are located in the deepest part of the brain.
  • Patients experience meningitis.
  • Hydrocephalus occurs.
  • Toxoplasmosis in people with HIV or AIDS.

If the patient has an abscess measuring above 2cm, at risk of rupture in the brain or has an element of gas in it, an ordinary doctor will advise to remove it through surgery. There are 2 types of actions commonly used, namely simple aspiration and craniotomy.

Simple aspiration is done by drilling a small hole (or commonly called a burr hole) in the skull so that pus can be removed. This action is usually done with the help of a CT scan tool to ascertain the point of the abscess. This operation tends to require a short time, which is about 1 hour.

If medication or simple aspiration measures do not help, a craniotomy will be performed. In this action, the doctor will cut a small portion of hair on the scalp and remove a small portion of the skull (flap) to open access to the brain. Then, the abscess will be fully removed after the pus is cleared and the bone flap will be returned to its original position when the action is complete. CT scans are also used to help doctors relocate abscess points. This operation will take longer, which is around 3 hours. After this surgery, the patient needs a full rest for 6-12 weeks.

Some complications, though rare, can occur after surgery for a craniotomy, such as swelling or bruising on the face, months of dizziness, blood clots in the brain, stiff jaws, or feeling a shift in bone flaps. Regular control is needed to reduce the risk of these complications.

It is recommended to avoid activities that are considered dangerous for the skull after surgery is performed, such as playing soccer or boxing. Patients are also not allowed to drive a vehicle until the doctor allows it, in anticipation of a sudden seizure.

Complications
If not handled properly, the following complications of brain abscess can occur:
  • An abscess that recurs.
  • Medium to severe brain damage.
  • Epilepsy or convulsions.
  • Meningitis, especially in children.
  • Otitis media (middle ear infection).
  • Sinusitis (sinus infection).
  • Mastoiditis (bone infection behind the ear).
Prevention
Since brain abscesses are often triggered by certain diseases, it is recommended to carry out regular checks so that this condition can be prevented as early as possible.

For those who suffer from heart disorders, doctors will usually give a series of antibiotics before doing dental treatment or other measures to prevent the risk of infection spreading to the brain. It is recommended to always tell the doctor before taking any medical action while undergoing brain abscess treatment.



• Lakshmi, V., Umabala, P., Anuradha, K., Padmaja, K., Padmasree, C., Rajesh, A., et al. (2011). Microbiological spectrum of brain abscess at a tertiary care hospital in South India: 24-year data and review. Pathol. Res. Int. 2011:583139. doi: 10.4061/2011/583139 • Neurosurgery (2018). Brain Abscess. • NHS Choices UK (2016). Health A-Z. Brain Abscess. • NIH (2017). MedlinePlus. Brain Abscess. • Wint, et al. Healthline (2017). Brain Abscess.

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