He Brain abscess Is a type of brain infection that some specialists define as a suppurative process, in which there is an accumulation of pus and dead cells. It is a serious and potentially fatal medical condition, although it is rare (Wint & Solan, 2016).
Bacterial agents are generally the most common cause of brain abscess development (Wint & Solan, 2016).
Although the diagnosis of this infection is complicated, especially in the early stages of presentation Of symptoms (Uninet, 2016), however, new brain imaging methods ( magnetic resonance , Computed tomography , etc…) Have significantly facilitated early and accurate identification of brain abscesses (Laurichesse, Siussi and Leport, 2009).
On the other hand, therapeutic interventions in brain abscesses usually focus on the administration of antibiotic drugs and on surgical interventions (Martínez-Castillo et al., 2013).
Characteristics of brain abscesses
A cerebral access or" Brain abscess "Is defined as a focal infection within the cerebral parenchyma, ie, in brain tissue (Alvis Miranda et al., 2013).
In addition, it is a form of intracranial suppuration that supposes a medical emergency that puts at risk the life of the person (Alvis Miranda et al., 2013).
Generally, brain abscesses begin by showing a localized ischemic or necrotic area, with inflammation of the brain tissue. This is followed by the deposition of leukocyte antigens (Neurology, 2016).
The leukocyte antigens fulfill an immune function and, therefore, try to protect the organism from the agents they generate infection. At the macroscopic level, the deposition of this type of agent is manifested by the presence of pus.
Pus is a thick liquid with a yellowish or greenish color, which is secreted or suppurated by inflamed tissues. Generally, this substance consists of serum, leukocytes, dead cells and Other agents (RAE, 2016).
Subsequent to these events, the area of the necrotic area has to increase and also the suppuration of pus (Neurology, 2016).
The affected or purulent area is then delimited and begins to develop a neo-vascularization (Formation of new blood vessels) around it (Neurology, 2016).
In the final phase, the affected area is surrounded by a capsule that maintains the infectious process (Neurology, 2016).
About us
Brain abscesses are a medical condition that has become uncommon or frequent in the more developed countries, especially since the second half of the 20th century, thanks to medical and technological advances (Laurichesse, Siussi and Leport, 2009)
Statistical data show that brain abscesses have an incidence ranging from 0.3-1 cases per 100,000 person-years in the general population (Laurichesse, Siussi and Leport, 2009).
Although the low incidence of this pathology is mainly due to the introduction of new antimicrobial drugs and the development of Brain imaging studies, remains a potentially deadly condition (Brook, 2016).
When a brain abscess capsule ruptures, the person may die in approximately 80% (Brook, 2016).
In addition, of those who survive, between 20-79% will present neurological sequelae following the infectious process (Brook, 2016).
Regarding sex, some specialists point out that brain abscesses are more frequent in men than in men. Women (Brook, 2016).
On the other hand, as to age, brain abscesses are considered a rare disease or pathology in the pediatric age (Borrero Domínguez et al., 2005).
Studies show that brain abscesses have an estimated incidence of about 4 cases per million people of child-bearing age (Borrero Domínguez et al., 2005).
Characteristic signs and symptoms
Our Central Nervous System (CNS) is actually susceptible to any damage or injury affecting nerve tissue.
Thus, infectious processes can lead to a wide variety of neurological symptoms when they affect brain tissue and Adjacent structures.
Patients suffering from this type of localized infection usually present a poor clinical specificity (Gómez et al., 2008).
Thus, the characteristic signs and symptoms of brain abscess appear insidiously (Laurichesse, Siussi and Leport, 2009), evolving over days or weeks, usually the duration of symptoms is at least two weeks (Uninet,
2016).
The clinical course of brain abscesses usually includes (Laurichesse, Siussi and Leport, 2019):
- Intracranial hypertension : Increase of the pressure that the cerebrospinal fluid (CSF) exerts within the intracranial vault.
- Intracerebral tumor syndrome : The presence of the purulent capsule, can act in the same way as the formation of a mass Tumor, resulting in a compression of the nervous tissues and consequent to the development of diverse neurological symptoms (epileptic seizures, deficits Cognitive, motor disorders, etc...).
- Headache headache , Usually severe and persistent. Typically, this symptom is present in the majority of those affected and Can be unilateral or bilateral. Headaches usually begin progressively.
- Nausea and vomiting : General malaise, recurrent nausea and vomiting are usually present in more than 50% of people Affected.
- Generalized convulsive seizures : Crises or epileptic discharges are less frequent, as they occur in approximately one 30% of cases.
- Papillary edema : Process of inflammation of the Optic papilla , Located at the bottom of the eye through which the optic nerve accesses Reach the brain tissue. Like the previous one, it is a rare symptom, present in approximately 25% of the cases.
- Moderate fever : The elevation of temperature is usually moderate and occurs in approximately 50% of cases.
On the other hand, it is also possible that the brain abscesses debuted with other Clinical forms S (Laurichesse, Siussi and Leport, 2009);
- S Febrile intracranial hypertension syndrome : Development of severe headaches, vomiting, nausea, seizures, fever, etc... Acute beginning in the form of meningitis And acute onset in the form of meningeal hemorrhage.
In addition to this, if the diagnosis is made late, the brain abscess progresses by increasing the suppuration of pus, the Cerebral edema and the Intracranial pressure. Because of this, it is possible that some serious neurological symptoms appear as:
- Confessional state.
- Spatial-temporal disorientation.
- Persistent and frequent seizures.
- Loss of consciousness.
- Coma.
Causes
Brain abscesses develop as a consequence of the existence of an infectious process.
Although this medical entity usually presents a diverse etiology, there are risk factors that allow to identify the approximate cause and the Location of infection (Martínez-Castillo, 2013).
Some of the predisposing factors are (Martínez-Castillo, 2013):
- Infections of contiguous or adjacent structures.
- Cranioencephalic injuries .
- Neurosurgery.
- Distant infection focus.
In this way, different infectious agents, viruses or bacteria, can reach the brain tissue, giving rise to the formation of the purulent capsule.
In the case of cerebral abscesses of bacterial origin, the streptococci Are the most common pathogens, Approximately 70% of the cases.
Diagnosis
In many cases of brain abscess, the diagnosis is not simple, and since the symptoms are nonspecific.
Much of the symptomatology resembles that of other pathologies or diseases of neurological origin (Wint & Solan, 2016).
In the case of brain abscesses, the neurological examination performed through various brain imaging tests, such as resonance Magnetic resonance imaging or computerized tomography (Wint & Solan, 2016).
The neuroimangen tests allow us to determine anatomically the presence of brain lesions, such as abscesses.
On the other hand, it is also common for the medical specialist in charge of the case to request other laboratory tests such as blood cultures or puncture To determine the presence of an infectious agent (Wint & Solan, 2016).
Treatments
Currently, medical advances have allowed the development of different therapeutic options. The choice of one of these will depend on the Characteristics of the brain abscess and the clinical characteristics of the affected person.
Usually, the most common treatment includes pharmacological and surgical intervention.
Pharmacotherapy (Laurichesse, Siussi and Leport, 2009)
The approach of brain abscesses by pharmacological treatment usually focuses the use of antibiotic therapies, termed antibiotic therapy.
Usually, antibiotics are recommended for the treatment of brain abscesses that do not exceed 2.5 centimeters.
In the first few weeks, high doses of these drugs are often used to ensure sufficient penetration and concentration of antibiotics In brain tissue.
Typically, this type of treatment lasts approximately 6-8 weeks, and can reach up to 3-6 months in severe cases that do not Can be operated.
Surgical treatment (Laurichesse, Siussi and Leport, 2009)
Surgical interventions are used for both the therapeutic approach and the diagnosis, usually indicated in Those abscesses that have a size larger than 2.5 centimeters.
Several techniques of neurosurgery, allow a puncture-biopsy in the affected place. Thus, these procedures Evacuation of pus, leading to decompression of brain tissue.
On the other hand, the complete excisions of the capsules usually involve a procedure with great risks for the patient, for Both are restricted to serious cases in which the other measures have not been effective.
Forecast
When a diagnosis of brain abscess is made, it is fundamental to perform a medical approach early, treat neurological complications And follow up.
Although current therapies help control the progression of this pathology, those affected die in up to 5-10% of cases (Borrero Domínguez et al. Al., 2005).
Although it is a pathology that endangers the life of the person, mortality has been reduced by approximately 25%, in cases of stay In intensive care units (Laurichesse, Siussi and Leport, 2009).
On the other hand, the neurological sequelae are prevalent (30-5%), some are mild, while others may imply more symptomatology Significant as epilepsy (Laurichesse, Siussi and Leport, 2009).
References
- A, Alvis Miranda, H., Castellar-Leones, S., & Moscote-Salazar, L. (2016). Brain abscess: Current management. Journal of Neurosciences in Rural Practice .
- Borrero-Domíngez, R., Navarro Gómez, M., Gómez-Campderá, J., & Carreras Fernández, J. (2005). Childhood brain abscess. An Pedriatr (Barc), 63 (3), 253-258.
- Brook, I. (2016). Brain Abscess . Obtained from Medscape.
- Laurichesse, J., Souissi, J., & Leport, C. (2009). Brain abscess. EMC (Elsevier Masson SAS, Paris), Traité de Médecine Akos .
- Martínez Castillo, E., Chacón-Pizano, E., & Mejía-Rodríguez, O. (2013). Brain abscess. Aten. Fam., 20 (4), 130.
- Neurology. (2016). CEREBRAL ABSCESS [ICD-10: G06.0] . Obtained from Neurology.
- UCC. (2016). Forms of inflammation . Obtained from General Pathology Manual.
- Uninet. (2016). Chapter 4. 1. Acute infections of the central nervous system . Obtained from Emergency, Emergency and Care Principles Critics.
- Wint, C., & Solan, M. (2015). Brain Abscess . Retrieved from Healthline.