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Brain Abscess, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications

A brain abscess is an infection caused by bacteria 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 of patients due to head injuries or infections in other tissues around the head. Although rare, brain abscesses are one of the infectious diseases that can endanger lives and must be addressed immediately. Anyone can experience it, the risk of this disease usually increases in people with a history of certain diseases such as:

  • Cancer, HIV / AIDS, and chronic diseases.
  • Infection of the ear in the middle (otitis media).
  • Sinusitis
  • Congenital heart disease, or commonly called the tetralogy of Fallot (ToF).
  • Meningitis.

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

Brain Abscess

Causes of Brain Abscess.

The main cause of brain abscess is a bacterial or fungal infection that enters a person's brain tissue because the person's immune system cannot fight it. Actually, our body is equipped with an immune system that functions to maintain important organs. But certain cases, these germs can enter through a person's blood vessels and directly attack the brain. Infections that enter the brain will accumulate in the brain tissue and form lumps of pus.

Certain diseases that can cause brain abscesses, such as the following:

  • Cyanotic heart disease. One type of congenital heart disease that results in a person's heart being unable to drain oxygen throughout the body and trigger infection.
  • Pulmonary arteriovenous fistula. Abnormalities that occur in blood vessels in the lungs, causing bacteria to enter the blood and flow to the brain.
  • Tooth Abscess.
  • Infection. These conditions include infections of the lungs (eg pneumonia), heart infections (eg endocarditis), infections in the abdominal cavity (eg peritonitis), pelvic infections (eg cystitis), and skin infections.

Brain Abscess Symptoms

Symptoms of a brain abscess will usually be felt within weeks after infection, sometimes also directly. The following are symptoms that can occur in people with brain abscesses:

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

Some symptoms can be seen if your baby or child has a brain abscess, such as:

  • Gag.
  • Crying in a high tone.
  • The body muscles look stiff.

Immediately see a doctor if symptoms continue to be felt, especially for those who experience sudden seizures, the speech starts to become unclear, muscles weaken, or paralysis.

Brain Abscess Diagnosis

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

  • Neurological examination, which includes movement of the muscular system, nervous system, and sensory. Blood test, to check if there are certain infections in the patient.
  • Scanning, to see the location of inflammation or swelling that occurs. Scanning such as X-rays, CT scans, EEGs, or MRIs.
  • Lumbar puncture. A sampling of cerebrospinal fluid from the spinal cord to examine the patient if there are certain bacteria. This action cannot be done if the patient has very severe brain swelling, because it can make the pressure in the brain worse.

If the results of the follow-up test do not identify the cause and source of the infection, the doctor will usually recommend a biopsy.

Brain Abscess Treatment

Brain abscess is an emergency condition and must be dealt with immediately. Treatment will be carried out in the hospital with antibiotics or antifungal drugs until the patient enters a stable stage. Sometimes, diuretic drugs will also be prescribed by a doctor. If the patient's condition is bad enough, the doctor will 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, is 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 performing this surgery, the patient must rest for 6-12 weeks afterward.

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.

Brain Abscess Complications

If not treated 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 of Brain Abscesses

Since brain abscesses are often triggered by certain diseases, it is recommended to carry out routine checks so that these conditions 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 the infection spreading to the brain. It is recommended to always tell the doctor before taking any medical action while undergoing brain abscess treatment.
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