🌟 Brain abscess

 🎯 Pathology

• a localised area of pus with a surrounding membrane embedded within the brain parenchyma

​

💡 Causes

• direct local spread

  • acute otitis media

  • mastoiditis

  • penetrating neck injuries

• haematogenous spread

  • pulmonary infections are the most common: pneumonia, bronchiectasis, cystic fibrosis

  • cyanotic congenital heart diseases

​

🧫 Most common causative agents

• Staphylococcus aureus

• Streptococcus viridans

​

🩺 Clinical features

• headache

• altered mental status

• focal neurological deficits (depends on the area of the brain impacted)

• fever

• seizures

• signs of raised intracranial pressure

  • nausea, vomiting, papilloedema

​

🕵️‍♂️ Investigations

• routine blood tests (e.g. FBC, U&E, CRP, ESR)

• blood cultures

• neuroimaging

  • CT: shows a rim of enhancement around the mass

  • MRI is better

​

💆‍♂️ Management

• IV antibiotics +/- steroids (e.g. dexamethasone)

• surgery to drain the abscess

• manage raised intracranial pressure

​

🧲 High-yield tips

• headache + fever + altered mental status + focal neurological deficits + signs of raised ICP = think brain abscess