Brain abscess

 Brain abscess (or cerebral abscess) is definitely an abscess caused by inflammation and assortment of infected material, originating from local (ear infection, dental abscess, infection of paranasal sinuses, infection from the mastoid air cells from the temporal bone,epidural abscess) or remote (lung, heart, kidney etc.) infectious sources, inside the brain tissue. The problem may also be introduced via a skull fracture carrying out a head trauma or surgical treatments. Brain abscess is usually associated withcongenital cardiovascular disease in young children. It might occur at all ages but is most typical in the third decade of life.
Deadly brain abscesses because of infection caused from tongue piercings have occurred


Clinical features
The the signs of brain abscess are caused by a mix of increased intracranial pressure as a result of space-occupying lesion (headache, vomiting, confusion, coma), infection (fever, fatigue etc.) and focal neurologic brain injury (hemiparesis,aphasia etc.). The most frequent presenting symptoms are headache, drowsiness, confusion, seizures, hemiparesis or speech difficulties along with fever with a rapidly progressive course. The symptoms and findings depend largely around the specific location from the abscess in the brain. An abscess within the cerebellum, for instance, may cause additional complaints due to brain stem compression and hydrocephalus. Neurological examination may reveal a stiff neck in occasional cases (erroneously suggesting meningitis). The famous triad of fever, headache and focal neurologic findings are highly suggestive of brain abscess.

Causes, incidence, and risks
Brain abscesses commonly occur when bacteria or fungi infect area of the brain. Swelling and irritation (inflammation) develop in reaction to this infection. Infected cognitive abilities, white blood cells, live and dead bacteria, and fungi collect within an area of the brain. Tissue forms for this area and creates full of.
While this immune response can safeguard the brain by isolating the problem, it can also do more damage than good. The brain swells. Since the skull cannot expand, the mass may put pressure on delicate brain tissue. Infected material can block the arteries of the brain.
The germs that create a brain abscess usually get to the brain through the blood. The origin of the infection is usually not found. However, the most typical source is a lung infection. More infrequently, a heart infection would be to blame. Germs could also travel from a nearby infected area (for instance, an ear infection or perhaps a tooth abcess) or go into the body during an injury (like a gun or knife wound) or surgery.
In youngsters with heart disease or perhaps a birth defect, for example those with tetralogy of fallot, infections tend to be more able to reach the brain in the intestines, teeth, or any other body areas.
The next raise your risk of a brain abscess:
• A weakened defense mechanisms (such as in AIDS patients)
• Chronic disease, for example cancer or Osler-Weber-Rendu syndrome
• Drugs that suppress the defense mechanisms (corticosteroids or chemotherapy)
• Right-to-left heart shunts, usually result of congenital cardiovascular disease


Symptoms
Symptoms may develop slowly, during a period of 2 weeks, or they might develop suddenly. They might include:
• Changes in mental status
• Confusion
• Decreasing responsiveness
• Drowsiness
• Eventual coma
• Inattention
• Irritability
• Slow thoughts
• Decreased movement
• Decreased sensation
• Decreased speech (aphasia)
• Fever and chills
• Headache
• Language difficulties
• Loss of coordination
• Loss of muscle function
• Seizures
• Stiff neck
• Vision changes
• Vomiting


Signs and tests
A brain and central nervous system (neurological) exam will often show increased intracranial pressure and issues with brain function.
Tests to identify a brain abscess can include:
• Blood cultures
• Chest x-ray
• Complete blood count (CBC)
• Head CT scan
• Electroencephalogram (EEG)
• MRI of head
• Testing for that presence of antibodies to organisms for example Toxoplasma gondii and Taenia solium
A needle biopsy is generally performed to identify the reason for the infection.

Treatment
A brain abscess is really a medical emergency. Pressure within the skull may become sufficient to be life threatening. You will have to stay in the hospital before the condition is stable. Many people may need life support.
Medication, not surgery, is usually recommended if you have:
• Several abscesses (rare)
• A small abscess (under 2 cm)
• An abscess deep within the brain
• An abscess and meningitis
• Shunts within the brain for hydrocephalus (in some instances the shunt may need to be removed temporarily or replaced)
• Toxoplasma gondii infection inside a person with HIV
Antibiotics is going to be prescribed. Antibiotics that actually work against a number of different bacteria (broad spectrum antibiotics) are most frequently used. You may be prescribed a number of different types of antibiotics to ensure treatment works.
Antifungal medications can also be prescribed if the infection is probably caused by a fungus.
Immediate treatment may be required if an abscess is injuring brain tissue by pressing onto it, or there is a large abscess having a large amount of swelling around that it's raising pressure within the brain.


Surgery is needed if :
• Pressure within the brain continues or worsens
• The brain abscess does not get smaller after medication
• The brain abscess contains gas (made by some types of bacteria)
• The brain abscess might break open (rupture)
Surgery includes opening the skull, exposing the mind, and draining the abscess. Laboratory tests in many cases are done to examine the fluid. It will help identify what is causing the problem, so that more appropriate antibiotics or antifungal drugs could be prescribed.
The surgical treatment used depends on the dimensions and depth from the abscess. The entire abscess may be removed (excised) if it's near the surface and enclosed inside a sac.
Needle aspiration guided by CT or MRI scan may be required for a deep abscess. In this procedure, medications might be injected directly into the mass.
Certain diuretics and steroids could also be used to reduce swelling from the brain.