A brain abscess also known as the cerebral abscess is a pocket of liquid that forms because of an infection or injury in the brain. It’s a very serious condition that can be life-threatening.
In the past, brain abscesses almost always led to death. However, since 2014, advances in how we find and treat them have greatly improved survival rates.
The impact of a cerebral abscess depends on how big it is and where it’s located in the brain.
Each year in the United States, there are between 1,500 to 2,500 cases of brain abscesses. They mostly affect adult males under 30 years old. In children, they’re most common among those aged 4 to 7 years old, and newborns are also having possibilities.
Vaccination programs have helped reduce the number of brain abscesses in kids.
Symptoms
Symptoms of a cerebral abscess can vary widely, but they typically include a headache, fever, seizures, vomiting, and nausea. A seizure might be the first indication of an abscess, while nausea and vomiting often occur due to increased pressure in the brain.
Pain typically starts near the abscess and can develop gradually or suddenly. Modifications in mental status are common, affecting about 65% of cases, leading to confusion, drowsiness, irritability, and difficulty focusing or responding. In severe cases, this can progress to slow thought processes or even coma.
Neurological problems are also prevalent, affecting 50-65% of individuals with brain abscesses. These problems, which often arise days or weeks after a headache, can include muscle weakness, paralysis on one body’s side, speech difficulties like slurred speech, and impaired coordination.
Additional symptoms may involve stiffness in the back, neck, or shoulders, as well as blurred, fading, or double vision. These symptoms arise from a combination of infection, damage to tissue of the brain, and pressure as the abscess develops and takes up more place.
If a headache suddenly worsens, it may indicate that the abscess has ruptured. Symptoms typically persist for up to two weeks in about two-thirds of cases, with doctors typically diagnosing the condition around eight days after symptoms first appear.
Causes
It is usually happening when bacteria, fungi, or parasites infect an area of the brain. This infection causes swelling and inflammation. The abscess forms when infected brain cells, along with agile and dead white blood cells, gather together with the harmful organisms.
As these cells build up, a protective membrane or wall forms over the abscess. This wall helps contain the infection and stops it from infecting healthy parts of the brain.
When an abscess grows, it puts pressure on the nearby brain tissue. Unlike other body parts, the skull is rigid and cannot expand. This pressure can block blood vessels, which stops oxygen from extending to the brain. Without enough oxygen, the brain tissue can be damaged or destroyed.
Pathways of Brain Infection
Brain infections are rare for several elements.
One reason is the blood-brain barrier, a safe system made of blood cells and vessels. It usually stops harmful substances from entering the brain but enters essential nutrients through.
Occasionally, inflammation can damage the blood-brain barrier, creating openings that allow infections to pass into the brain
Infections can get into the brain in three main ways:
- They can travel through the bloodstream from an infection in another body area.
- They can spread from a nearby area, like the ear.
- They can develop from a traumatic surgery or injury.
Diagnosis
To determine a cerebral abscess, the healthcare will assess the patient’s symptoms and signs and review their recent travel and medical histories. They will be required to know if the individual has recently had an infection or if they have a weak immune system.
Since the symptoms of a cerebral abscess can be the same as those of other illnesses, confirming a diagnosis may take some time. It becomes easier if the healthcare provider can identify when the symptoms began and how they have developed over time
Several tests may be used to diagnose a cerebral abscess:
- A blood examination is to measure for high ranges of white blood cells, which can show an infection.
- Scans, such as an MRI or CT scan, where an abscess will appear as single or more spots.
- A CT-guided aspiration is a kind of needle biopsy, where a pus sample is taken for examination.
The number of deaths from brain abscesses has decreased in recent times, because of the routine use of MRI and CT scans for identification.
Treatment
Brain abscess treatment typically involves medication and surgery. If a healthcare provider doubts a cerebral abscess, they will usually start with broad-spectrum antibiotics immediately because an abscess can be dangerous. If tests later appear that the infection is viral instead of bacterial, the healthcare provider will adjust the medication accordingly.
The efficiency of the medication depends on several factors, including the size and number of abscesses, the cause of the abscess, and the patient’s overall health.
For abscesses less than 1 inch across, the patient will likely receive intravenous antifungal, antibiotic, or antiviral medication. But the healthcare provider may still need to drain a smaller abscess to determine the most effective antibiotics.
For abscesses larger than 1 inch across, a healthcare provider will require to aspirate, drain, or surgically eliminate. If there are multiple abscesses, surgery to eliminate them may be too risky, and aspiration might be recommended instead.
Additionally, the patient will require treatment for any basic infection, such as those in the abdomen, lungs, or nose.
Surgery
Surgery may be necessary for a cerebral abscess if the pressure in the brain persists to increase, the abscess does not answer to treatment, there is gas present in the abscess, or there is a chance that the abscess may burst. A common surgical procedure for treating brain abscesses is a craniotomy. During this procedure, the surgeon shaves a small part of the scalp and removes a tiny piece of bone to check the brain. The abscess is then either removed or drained, sometimes with the help of a CT scan. Afterward, the bone is replaced, and the skin is stitched up.
Medication
If there is increased pressure inside the skull and a chance of complications like meningitis, a short course of high-dose corticosteroids may help. However, corticosteroids are not prescribed routinely.
Doctors may prescribe anticonvulsants to reduce seizures. Patients who affected brain abscess may require the use of anticonvulsants for up to five years.
Outlook
Studies say that 5-32% of brain abscesses can be life-threatening. For those who live, there might be long-lasting effects depending on the transmission of the damage. A cerebral abscess can cause long-term neurological issues, such as difficulties with physical movement, seizures, and personality changes.
It’s crucial to recognize the possible signs of a cerebral abscess and provide medical assistance immediately if they occur. The earlier a person gets treatment, the more effective it is possible to be, increasing the chances of living.
The outlook also relies on the specific features of the abscess. Multiple abscesses or those situated deep within the brain are more challenging to treat.
During recovery, the doctor will closely monitor the patient, as there is a risk of the abscess returning. This may involve weekly CT scans for at least two weeks. Because an abscess can recur even after months or years, long-term observation is essential.
Summary
A cerebral abscess is a serious, potentially life-threatening condition caused by bacterial, fungal, or parasitic infections. Symptoms include headaches, fever, seizures, and changes in mental status. Diagnosis involves a medical history review, blood tests, and imaging scans. Treatment typically includes surgery and medication, depending on the size and location of the abscess. Prompt treatment improves survival rates, but long-term neurological issues may persist. Continuous monitoring is crucial, as abscesses can recur even years later.
