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Brain Abscess

Description
  • A brain abscess is a collection of infectious material within the tissue of the brain.
  • Bacteria are the most common causative organisms. An abscess can result from intra-cranial surgery, penetrating head injury, or tongue piercing.
  • Organisms causing brain abscess may reach the brain by hematologic spread from the lungs, gums, tongue, or heart, or from a wound or intra-abdominal infection. It can be a complication in patients whoseimmune systems have been suppressed through therapy or disease.

Prevention
  • To prevent brain abscess, otitis media, mastoiditis, rhinosinusitis, dental infections, and systemic infections should be treated promptly.
Clinical Manifestations
  • Generally, symptoms result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess.
  • Headache, usually worse in morning, is the most prevailing symptom.
  • Fever, vomiting, and focal neurologic deficits (weakness and decreasing vision) occur as well.
  • As the abscess expands, symptoms of increased intracranial pressure (ICP) such as decreasing level of consciousness and seizures are observed.

Assessment and Diagnostic Methods
  • Neuroimaging studies such as MRI or CT scanning to identify the size and location of the abscess
  • Aspiration of the abscess, guided by CT or MRI, to culture and identify the infectious organism
  • Blood cultures, chest xray, electroencephalogram (EEG)

Medical Management
  • The goal is to eliminate the abscess.
  • Treatment modalities include antimicrobial therapy, surgical incision, or aspiration (CTguided stereotactic needle).
  • Medications used include corticosteroids to reduce the inflammatory cerebral edema and antiseizure medications for prophylaxis against seizures (phenytoin, phenobarbital).
  • Abscess resolution is monitored with CT scans.

Nursing Management
  • Nursing interventions support the medical treatment, as do patient teaching activities that address neurosurgical procedures.
  • Patients and families need to be advised of neurologic deficits that may remain after treatment (hemiparesis, seizures, visual deficits, and cranial nerve palsies).
  • The nurse assesses the family’s ability to express their distress at the patient’s condition, cope with the patient’s illness and deficits, and obtain support.

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