neuroinfection

1. BRAIN ABSCESS
By,
Ms. Ekta S Patel,
II Year M.Sc Nursing
MSN(Neuroscience)

2. Introduction:
• A brain abscess is a collection of
pus enclosed in the brain tissue,
caused by a bacterial or fungal
infection.

3. • Brain abscess (or cerebral abscess) is an
abscess caused by inflammation and
collection of infected material, coming from
local (ear infection, dental abscess, infection of
paranasal sinuses, infection of the mastoid air
cells of the temporal bone, epidural abscess)
or remote (lung, heart, kidney etc.) infectious
sources, within the brain tissue.

4. • The infection may also be introduced
through a skull fracture following a head
trauma or surgical procedures.
• Brain abscess is usually associated with
congenital heart disease in young
children. It may occur at any age but is
most frequent in the third decade of life.

5. Definition:
• Brain abscess is defined as
purulence and inflammation in
one or more localized regions
within the brain parenchyma.

6. Causes and risk factors:
• Nearly anyone can get a brain
abscess, but certain groups of
people are at a higher risk than
others. Some diseases, disorders,
and conditions that raise your risk
include:

7. • A compromised immune system
due to HIV or AIDS
• Cancer and other chronic illnesses
• Congenital heart disease
• Major head injury or skull fracture

8. • Meningitis
• Immunosuppressant drugs, such
as those used in chemotherapy
• Chronic sinus or middle ear
infections

9. Sign and symptoms
• Symptoms may develop slowly,
over a period of 2 weeks, or
they may develop suddenly.
They may include:

10. 1. Changes in mental status
• Confusion

11. • Decreasing
responsiveness

12. • Drowsiness

13. • Eventual coma

14. • Inattention

15. • Irritability

16. • Slow thought processes

17. 2. Decreased movement
3. Decreased sensation
4. Decreased speech
(aphasia)
5. Fever and chills
6. Headache

18. 7. Language difficulties
8. Loss of coordination
9. Loss of muscle function,
typically on one side
10. Seizures
11. Stiff neck
12. Vision changes
13. Vomiting

19. Diagnostic evaluation:
• A brain and nervous system
(neurological) exam will usually
show signs of increased
intracranial pressure and
problems with brain function.
• Tests to diagnose a brain abscess
may include:
• Blood cultures

20. • Chest x-ray
• Complete blood count (CBC)
• Head CT scan
• Electroencephalogram (EEG)
• MRI of head
• Testing for the presence of antibodies to
organisms such as Toxoplasma gondii
and Taenia solium

21. • A needle biopsy is usually
performed to identify the
cause of the infection.

22. Treatment:
• A brain abscess is a medical
emergency. Pressure inside
the skull may become high
enough to be life threatening.
Patient need to stay in the
hospital until the condition is
stable. Some people may need
life support.

23. Medication, not surgery, is
recommended if patient have:
• Several abscesses (rare)
• A small abscess (less than 2 cm)
• An abscess deep in the brain
• An abscess and meningitis
• Shunts in the brain for hydrocephalus (in some
cases the shunt may need to be removed
temporarily or replaced)

24. • Toxoplasma gondii
infection in a person with
HIV

25. • Antibiotics will be prescribed.
Antibiotics that work against a
number of different bacteria (broad
spectrum antibiotics) are most
commonly used.

26. • Antifungal medications may also
be prescribed if the infection is
likely caused by a fungus.
• Immediate treatment may be
needed if an abscess is injuring
brain tissue by pressing on it, or
there is a large abscess with a
large amount of swelling around
that it is raising pressure in the
brain.

27. Surgery is needed if:
• Increased pressure in the brain continues
or gets worse
• The brain abscess does not get smaller
after medication
• The brain abscess contains gas (produced
by some types of bacteria)
• The brain abscess might break open
(rupture)

28. • Surgery consists of opening the skull,
exposing the brain, and draining the
abscess. Laboratory tests are often
done to examine the fluid. This can
help identify what is causing the
infection, so that more appropriate
antibiotics or antifungal drugs can be
prescribed.

29. • The surgical procedure used
depends on the size and depth of
the abscess. The entire abscess
may be removed (excised) if it is
near the surface and enclosed in
a sac.

30. • Needle aspiration guided by CT or
MRI scan may be needed for a deep
abscess. During this procedure,
medications may be injected directly
into the mass.
• Certain diuretics and steroids may
also be used to reduce swelling of the
brain.

31. Prognosis:
• If untreated, a brain abscess is almost
always deadly. With treatment, the death
rate is about 10 - 30%. The earlier treatment
is received, the better.
• Some patients may have long-term
neurological problems after surgery.

32. Complications:
• Brain damage
• Meningitis that is severe and life
threatening
• Return (recurrence) of infection
• Seizures

33. Nursing Management & Interventions
• Nursing interventions
should support the medical
treatment, as do patient
teaching activities that
address neurosurgical
procedures.

34. • Patients and families need to
be advised of
neurologic deficits that may
remain after treatment
(hemiparesis,
seizures, visual deficits, and
cranial nerve palsies).

35. • Frequently assess neurologic status,
especially LOC, speech and
sensorimotor and cranial nerve
functions.
• WOF signs of increased ICP: decreased
LOC, vomiting, abnormal pupil response
and depressed respirations.

36. • 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.
• Always provide safety measures.