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Presentations and Management of Intracranial Abscess.pptx

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CHIZOWA EZEAKU
CHIZOWA EZEAKU

summary on intracranial abscess with emphasis on aetiology, pathogenesis, pathology, forms of presentations , investigations and treatment options of brain abscess.

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PRESENTATION AND MANAGEMENT OF INTRACRANIAL ABSCESS EZEAKU , CHIZOWA OKWUCHUKWU 1
CASE PRESENTATION 1 • A .E, 4 year old female presented 4 days ago on account of seizure and left extremity weakness noticed 1 day ago. • There was an antecedent history of fever 1 week ago, managed with OTC drugs. • Examination revealed left hemiparesis LL>UL with hemiparetic gait. • CT scan showed a ring enhancing hypodense region measuring 1.67cm with marked perilesional edema in the right frontal lobe 2
CASE PRESENTATION 1 • A diagnosis of Brain abscess ? Hematogenous route was made • She is currently on IV antibiotics, steroid and anticonvulsant • Neurology has improved since commencement of treatment 3
CASE PRESENTATION 2 • L.G , 55 year old male presented 3 weeks on account of headache with discharging right scalp wound .Had a machete cut a week earlier which was managed at home. • Examination findings showed a 4X 6 cm wound on the right frontal aspect of the scalp with seropurulent discharge. • CT scan showed depressed communited frontal bone fracture. • Had craniotomy with debridement and elevation of depressed fracture. 4
CASE PRESENTATION 2 • 9 days later, developed altered sensorium with progressive purulent discharge from traumatic wound. • Repeat CT scan showed a right frontal lobe ring enhancing hypodense lesion measure about 4cm with perilesional oedema with effacement of the ipsilateral lateral ventricle. • Assessment : Brain abscess 2 to direct contiguous spread . • Had craniotomy, wound debridement with aspiration of abscess. • Currently on IV antibiotics. 5
• INTRODUCTION • EPIDEMIOLOGY • CLASSIFICATION • AETIOPATHOGENESIS • PATHOLOGY • CLINICAL FEATURES • INVESTIGATIONS • DIFFERENTIAL DIAGNOSIS • TREATMENT OPTIONS • COMPLICATIONS • PROGNOSIS • LOCAL EXPERIENCE • FUTURE TRENDS • CONCLUSION 6
INTRODUCTION • Intracranial abscess consist of a collection of immune cells, pus, and necrotic materials within the intracranial cavity. • Usually from a bacterial, fungal, or protozoan infection 7
BRIEF HISTORY •Intracranial abscesses has been a recognized disease entity since antiquity. • Hippocrates made the first association between otorrhea and delirium. • The first documented successful operation for intracranial abscess – S.F. Morand in 1752. 8
EPIDEMIOLOGY • Approx 1,500 -2500 cases reported annually in the United States • M: F= 2.8 : 1.0 (SW, Nigeria) • Mean age : 25.6yrs • Commonest location: Frontal lobe(41%-UBTH, 32%(Memfy,UNTH) • Mortality been showing a downward trend(0-24%) 9
CLASSIFICATION • Based on location Intraparenchymal 50% Subdural 25% Extradural 22% Intraventricular 3% 10
CLASSIFICATION • Based on number • Solitary • Multiple(5-50%) 11
CLASSIFICATION • Based on causative agent • Pyogenic abscess • Tuberculous abscess • Fungal abscess( Aspergillius, Candida, Histoplasma) 12
Hemispheric Distribution • Right hemisphere 45% • Left hemisphere 32% • Bilateral 12.5% • Multiple 9% 13
AETIOPATHOGENESIS(Risk factors) Patient factor • Age • Poor physical condition- malnutrition, immunosuppression, infection at secondary site (UTI, Chest infections), congenital heart diseases • Local factors- dehydration, hypoxia, devitalised tissue Surgical factor • Re-operation • Long operation times • Inadequate aseptic technique • Large surgical fields 14
AETIOPATHOGENESIS • Abscess initiation: • Disruption of the major brain barriers(BBB, BCSFB) • Development and initiation depends : • Organism(Virulence, dose, route of entry) • Patient factors • Anatomical defenses(Skull, meninges) • Physiological: Immune defense mechanisms 15
AETIOPATHOGENESIS • Direct spread (40-50%) (Contiguous foci) • Hematogenous (25-35%) (Remote foci) • Penetrating trauma/surgery (10%) • Cryptogenic (15-20%) 16
Predisposing Condition Usual Microbial Isolates Otitis media or mastoiditis Streptococci (anaerobic or aerobic), (Temporal lobe/ cerebellum) Bacteroides and Prevotella spp., Enterobacteriaceae Sinusitis (frontoethmoid or sphenoid) Streptococci, Bacteroides spp., (Frontal lobe /sella turcica) Enterobacteriaceae, Staph. aureus, Haemophilus spp. Dental sepsis Fusobacterium, Prevotella and (Frontal lobe> Temporal) Bacteroides spp., streptococci Penetrating trauma or postneurosurgical S. aureus, streptococci, Enterobacteriaceae, Clostridium spp. 17
• Lung abscess, empyema, bronchiectasis : Fusobacterium, Actinomyces, Bacteroides Prevotella spp, streptococci, Nocardia • Bacterial endocarditis :S. aureus, streptococci • Congenital heart disease Streptococci, Haemophilus spp. • Neutropenia Aerobic gram-negative bacilli, Aspergillus , Mucorales, • Transplantation Aspergillus spp., Candida spp., Mucorales, Enterobacteriaceae, Nocardia spp., Toxoplasma gondii • HIV infection Toxoplasma gondii, Nocardia spp., Mycobacterium spp., Listeria monocytogenes, Cryptococcus neoformans • PPID, 2000 18
PATHOGENESIS 19
Microscopy( 5 zones) 1. Necrotic core 2. Zone of inflammatory cells and fibroblast 3. Dense collagen capsule 4. Zone of neovascularization 5. Reactive astrocytes, gliosis, and cerebral edema 20
CLINICAL FEATURES • Depends on • Origin of infection /septic focus • Site • Size and number of lesions • Specific brain structures involved • The neighborhood anatomy disturbances involving cisterns, ventricles, and the dural venous sinuses • Predisposing risk factors • Any secondary cerebral injury 21
CLINICAL FEATURES • Present with features related to  Focal mass expansion  Raised intracranial pressure  Diffuse destruction, and Irritation of neural tissues 22
CLINICAL FEATURES 23
Possible Initial Findings in Patients with Brain Abscess Based on Intracranial Location INTRACRANIAL LOCATION FINDINGS Parietal lobe Headache Visual field deficits (ranging from inferior quadrantanopia to homonymous hemianopia) Frontal lobe Headache Drowsiness Inattention Personality change Mental status deterioration Hemiparesis Motor speech disorder Temporal lobe Ipsilateral headache Aphasia or dysphasia (if in the dominant hemisphere) Visual field deficit (ranging from upper quadrant homonymous quadrantanopia to complete homonymous hemianopia) 24
Possible Initial Findings in Patients with Brain Abscess Based on Intracranial Location Cerebellum Headache Nystagmus Ataxia Vomiting Dysmetria Meningismus Papilledema Brainstem Cranial nerve involvement Deficits of ascending and descending pathways 25
INVESTIGATIONS Radiologic • Magnetic resonance imaging (MRI) : Gold standard • Contrast enhanced Cranial computed tomography scan • Proton MR spectroscopy, Radiolabelled leucocyte scan • Skull x-rays Others • Aspirate for microbiological assessment +/- cytology • Full blood count/peripheral blood film • Blood culture • Erythrocyte sedimentation rate/ C-reactive protein • Others: Echocardiography ,Hb genotype, Chest X-ray, Quanteferon,RVS 26
27
28
29
DIFFERENTIAL DIAGNOSIS • Based on clinical features – Bacterial meningitis – Focal encephalitis – Brain tumour – Intracranial hematoma 30
DIFFERENTIAL DIAGNOSIS • Based on CT scan findings(Ring enhancing lesion) – Metastasis – Glioblastoma – Subacute infarct – Radiation necrosis – Neurocysticercosis 31
TREATMENT • Aim is to • Identify offending microorganism with appropriate antibiotic coverage • Remove the septic foci • Other supportive /useful adjuncts • Multidisciplinary approach 32
TREATMENT • Combined medical and surgical • Medical(selected cases) 33
Indications for surgery • Obtain culture specimen • Significant mass effect • Raised intracranial pressure • Evidence of foreign body or gas containing abscess • Proximity to ventricles • Poor neurological condition • Inability to obtain weekly CT scan • Fungal abscess • Failure of non operative management • Multiloculated abscess 34
Surgical options • Aspiration • Via Needle • Free hand aspiration • Stereotactic guided • Neuroendoscopic aspiration • Intraoperative ultrasound guided • Surgical excision via a craniotomy 35
Aspiration • Stereotactic aspiration recommended for small, multiple abscess or when located in inaccessible or eloquent area • Neuroendoscopic treatment, when compared to stereotactic aspiration, has additional advantage of more complete drainage and lavage especially in multiseptated or intraventricular abscess • Associated repeated procedure 36
Indications for craniotomy and abscess excision • Presence of foreign body • Post traumatic/ gas containing abscess • Superficial located abscess with thick membranes • Peripheral abscess resistant to aspiration or antibiotics • Cerebellar abscess • Abscess that results from fistulous communication 37
Contraindications for craniotomy with abscess excision • Abscesses in cerebritis stage • Deep seated abscesses in eloquent areas • Multiple abscesses 38
Specific Considerations • Multiple abscess(5% -50% )- surgical(aspiration) or medical only/combination • Cerebellar abscess(6-35%) -Posterior fossa craniotomy advised+/- ventriculostomy, however burr hole aspiration has emerged as a satisfactory method • Brainstem abscess-Posterior fossa craniotomy • Tubercular abscess- AntiTb with drainage • Subdural and epidural abscess- surgery(evacuation and membrane excision) plus antimicrobial therapy 39
Medical Therapy • Indicated for extremely poor surgical candidates with • Microabscess(<2cm-debatable) • Multiple abscess • Cerebritis stage • Inaccessible localization • Concomitant meningitis, ependymitis • Improvement on antibiotics therapy 40
41
Duration of antibiotic • Numerous recommendations • 6-8 weeks IV, followed by 2-3months oral • 12 weeks IV, for medical therapy alone • Post excision- 4 to 6 weeks antibiotics • Triple high dose therapy- 2 weeks IV, followed by 4 weeks oral • 3-12 months antimicrobial for the immunocompromsed 42
Radiographic monitoring • Cranial scans weekly during the course of therapy • One week after discontinuation of therapy • Scan one month later • Monthly or bimonthly until radiographic resolution 43
Role of Steroids • Controversial • Indications: • Impending brain herniation • Progressive neurological deterioration • Associated massive edema and mass effect • Prolonged use is discouraged 44
Role of anticonvulsants • Legg et al advocated 5year course for all patient with brain abscess. • Muzumdar etal recommended discontinuation after 2 years of seizure free, with no epileptic activity on EEG • Also anticonvulsant is recommended for children who develop seizure, most authors recommend providing at least 3 months of prophylaxis if no more seizures have occurred. 45
Role of Hyperbaric oxygen • In addition to surgery, hyperbaric oxygen therapy has been reported to be a useful adjunct • More useful in fungal brain abscess • Although no randomized, prospective studies have been performed to assess its efficacy. 46
COMPLICATIONS • Reoccurrence(10%) • Focal neurological deficit(30-50%) • Mental retardation • Seizure(70%) • Venous sinus thrombosis • Hydrocephalus • Septicemia • Meningitis • Ventriculitis 47
PROGNOSIS • Poor outcome associated with: • intraventricular rupture(80% mortality) • rapid progress prior to hospitalization • coma or stupor, • Initial GCS <12 • Aspergillosis(90%) • Comorbidities(Charlson scale >/2) 48
LOCAL EXPERIENCE • 5 cases • M: F=3:2 • Age:4-55yrs • Mortality rate : 40% 49
CURRENT TRENDS • 16S Ribosomal sequencing • Emphasis on stereotactic aspiration 50
CONCLUSION • Intracranial abscesses are uncommon, serious, life-threatening infections with varied aetiological agents and route of spread. • Its numerous presentation may pose a diagnostic dilemma to the clinician • High index of suspicion, prompt response with appropriate management will help to improve outcome 51
REFERENCE • Olorunmoteni OE, Onyia CU, Elusiyan JBE, Ugowe OJ, Babalola TE, Samuel I. Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature. Childs Nerv Syst. 2020 Aug;36(8):1767- 1771. doi: 10.1007/s00381-020-04529-2. Epub 2020 Feb 8. PMID: 32034520. • Udoh DO, Ibadin E, Udoh MO. Intracranial abscesses: Retrospective analysis of 32 patients and review of literature. Asian J Neurosurg 2016;11:384-91 • Chika Ndubisi,Samuel Ohaegbulam,Wilfred Mezue, Mark Chikani Management of Brain Abscess: Changing Trend and Experience in Enugu, Nigeria. July 2017Nigerian Journal of Surgery 23(2):106 52
REFERENCE • Vincent Thamburaj. Textbook of Contemporary Neurosurgey,Vol 1 • Friedman Em, etal.Intracranial complications of sinusitis in children.A sequuela of periapical abscess.Ann Otol Rhinol Laryngol.1982.41-3 • Brook I.Microbiology and treatment of brain abscess. J Clin Neurosci. 2017. 38:8-12 • Management of Brain Abscess. A seminar presentation by Dr Moses Inojie • Muzumdar D, Jhawar S, Goel A. Brain abscess: An overview. Int J Surg. 2011;9:136–44. • Legg NJ, Gupta PC, Scott DF. Epilepsy following cerebral abscess. A clinical and EEG study of 70 patients. Brain. 1973;96:259–68. 53
• THANK YOU FOR LISTENING 54

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Presentations and Management of Intracranial Abscess.pptx

  • 1. PRESENTATION AND MANAGEMENT OF INTRACRANIAL ABSCESS EZEAKU , CHIZOWA OKWUCHUKWU 1
  • 2. CASE PRESENTATION 1 • A .E, 4 year old female presented 4 days ago on account of seizure and left extremity weakness noticed 1 day ago. • There was an antecedent history of fever 1 week ago, managed with OTC drugs. • Examination revealed left hemiparesis LL>UL with hemiparetic gait. • CT scan showed a ring enhancing hypodense region measuring 1.67cm with marked perilesional edema in the right frontal lobe 2
  • 3. CASE PRESENTATION 1 • A diagnosis of Brain abscess ? Hematogenous route was made • She is currently on IV antibiotics, steroid and anticonvulsant • Neurology has improved since commencement of treatment 3
  • 4. CASE PRESENTATION 2 • L.G , 55 year old male presented 3 weeks on account of headache with discharging right scalp wound .Had a machete cut a week earlier which was managed at home. • Examination findings showed a 4X 6 cm wound on the right frontal aspect of the scalp with seropurulent discharge. • CT scan showed depressed communited frontal bone fracture. • Had craniotomy with debridement and elevation of depressed fracture. 4
  • 5. CASE PRESENTATION 2 • 9 days later, developed altered sensorium with progressive purulent discharge from traumatic wound. • Repeat CT scan showed a right frontal lobe ring enhancing hypodense lesion measure about 4cm with perilesional oedema with effacement of the ipsilateral lateral ventricle. • Assessment : Brain abscess 2 to direct contiguous spread . • Had craniotomy, wound debridement with aspiration of abscess. • Currently on IV antibiotics. 5
  • 6. • INTRODUCTION • EPIDEMIOLOGY • CLASSIFICATION • AETIOPATHOGENESIS • PATHOLOGY • CLINICAL FEATURES • INVESTIGATIONS • DIFFERENTIAL DIAGNOSIS • TREATMENT OPTIONS • COMPLICATIONS • PROGNOSIS • LOCAL EXPERIENCE • FUTURE TRENDS • CONCLUSION 6
  • 7. INTRODUCTION • Intracranial abscess consist of a collection of immune cells, pus, and necrotic materials within the intracranial cavity. • Usually from a bacterial, fungal, or protozoan infection 7
  • 8. BRIEF HISTORY •Intracranial abscesses has been a recognized disease entity since antiquity. • Hippocrates made the first association between otorrhea and delirium. • The first documented successful operation for intracranial abscess – S.F. Morand in 1752. 8
  • 9. EPIDEMIOLOGY • Approx 1,500 -2500 cases reported annually in the United States • M: F= 2.8 : 1.0 (SW, Nigeria) • Mean age : 25.6yrs • Commonest location: Frontal lobe(41%-UBTH, 32%(Memfy,UNTH) • Mortality been showing a downward trend(0-24%) 9
  • 10. CLASSIFICATION • Based on location Intraparenchymal 50% Subdural 25% Extradural 22% Intraventricular 3% 10
  • 11. CLASSIFICATION • Based on number • Solitary • Multiple(5-50%) 11
  • 12. CLASSIFICATION • Based on causative agent • Pyogenic abscess • Tuberculous abscess • Fungal abscess( Aspergillius, Candida, Histoplasma) 12
  • 13. Hemispheric Distribution • Right hemisphere 45% • Left hemisphere 32% • Bilateral 12.5% • Multiple 9% 13
  • 14. AETIOPATHOGENESIS(Risk factors) Patient factor • Age • Poor physical condition- malnutrition, immunosuppression, infection at secondary site (UTI, Chest infections), congenital heart diseases • Local factors- dehydration, hypoxia, devitalised tissue Surgical factor • Re-operation • Long operation times • Inadequate aseptic technique • Large surgical fields 14
  • 15. AETIOPATHOGENESIS • Abscess initiation: • Disruption of the major brain barriers(BBB, BCSFB) • Development and initiation depends : • Organism(Virulence, dose, route of entry) • Patient factors • Anatomical defenses(Skull, meninges) • Physiological: Immune defense mechanisms 15
  • 16. AETIOPATHOGENESIS • Direct spread (40-50%) (Contiguous foci) • Hematogenous (25-35%) (Remote foci) • Penetrating trauma/surgery (10%) • Cryptogenic (15-20%) 16
  • 17. Predisposing Condition Usual Microbial Isolates Otitis media or mastoiditis Streptococci (anaerobic or aerobic), (Temporal lobe/ cerebellum) Bacteroides and Prevotella spp., Enterobacteriaceae Sinusitis (frontoethmoid or sphenoid) Streptococci, Bacteroides spp., (Frontal lobe /sella turcica) Enterobacteriaceae, Staph. aureus, Haemophilus spp. Dental sepsis Fusobacterium, Prevotella and (Frontal lobe> Temporal) Bacteroides spp., streptococci Penetrating trauma or postneurosurgical S. aureus, streptococci, Enterobacteriaceae, Clostridium spp. 17
  • 18. • Lung abscess, empyema, bronchiectasis : Fusobacterium, Actinomyces, Bacteroides Prevotella spp, streptococci, Nocardia • Bacterial endocarditis :S. aureus, streptococci • Congenital heart disease Streptococci, Haemophilus spp. • Neutropenia Aerobic gram-negative bacilli, Aspergillus , Mucorales, • Transplantation Aspergillus spp., Candida spp., Mucorales, Enterobacteriaceae, Nocardia spp., Toxoplasma gondii • HIV infection Toxoplasma gondii, Nocardia spp., Mycobacterium spp., Listeria monocytogenes, Cryptococcus neoformans • PPID, 2000 18
  • 20. Microscopy( 5 zones) 1. Necrotic core 2. Zone of inflammatory cells and fibroblast 3. Dense collagen capsule 4. Zone of neovascularization 5. Reactive astrocytes, gliosis, and cerebral edema 20
  • 21. CLINICAL FEATURES • Depends on • Origin of infection /septic focus • Site • Size and number of lesions • Specific brain structures involved • The neighborhood anatomy disturbances involving cisterns, ventricles, and the dural venous sinuses • Predisposing risk factors • Any secondary cerebral injury 21
  • 22. CLINICAL FEATURES • Present with features related to  Focal mass expansion  Raised intracranial pressure  Diffuse destruction, and Irritation of neural tissues 22
  • 24. Possible Initial Findings in Patients with Brain Abscess Based on Intracranial Location INTRACRANIAL LOCATION FINDINGS Parietal lobe Headache Visual field deficits (ranging from inferior quadrantanopia to homonymous hemianopia) Frontal lobe Headache Drowsiness Inattention Personality change Mental status deterioration Hemiparesis Motor speech disorder Temporal lobe Ipsilateral headache Aphasia or dysphasia (if in the dominant hemisphere) Visual field deficit (ranging from upper quadrant homonymous quadrantanopia to complete homonymous hemianopia) 24
  • 25. Possible Initial Findings in Patients with Brain Abscess Based on Intracranial Location Cerebellum Headache Nystagmus Ataxia Vomiting Dysmetria Meningismus Papilledema Brainstem Cranial nerve involvement Deficits of ascending and descending pathways 25
  • 26. INVESTIGATIONS Radiologic • Magnetic resonance imaging (MRI) : Gold standard • Contrast enhanced Cranial computed tomography scan • Proton MR spectroscopy, Radiolabelled leucocyte scan • Skull x-rays Others • Aspirate for microbiological assessment +/- cytology • Full blood count/peripheral blood film • Blood culture • Erythrocyte sedimentation rate/ C-reactive protein • Others: Echocardiography ,Hb genotype, Chest X-ray, Quanteferon,RVS 26
  • 27. 27
  • 28. 28
  • 29. 29
  • 30. DIFFERENTIAL DIAGNOSIS • Based on clinical features – Bacterial meningitis – Focal encephalitis – Brain tumour – Intracranial hematoma 30
  • 31. DIFFERENTIAL DIAGNOSIS • Based on CT scan findings(Ring enhancing lesion) – Metastasis – Glioblastoma – Subacute infarct – Radiation necrosis – Neurocysticercosis 31
  • 32. TREATMENT • Aim is to • Identify offending microorganism with appropriate antibiotic coverage • Remove the septic foci • Other supportive /useful adjuncts • Multidisciplinary approach 32
  • 33. TREATMENT • Combined medical and surgical • Medical(selected cases) 33
  • 34. Indications for surgery • Obtain culture specimen • Significant mass effect • Raised intracranial pressure • Evidence of foreign body or gas containing abscess • Proximity to ventricles • Poor neurological condition • Inability to obtain weekly CT scan • Fungal abscess • Failure of non operative management • Multiloculated abscess 34
  • 35. Surgical options • Aspiration • Via Needle • Free hand aspiration • Stereotactic guided • Neuroendoscopic aspiration • Intraoperative ultrasound guided • Surgical excision via a craniotomy 35
  • 36. Aspiration • Stereotactic aspiration recommended for small, multiple abscess or when located in inaccessible or eloquent area • Neuroendoscopic treatment, when compared to stereotactic aspiration, has additional advantage of more complete drainage and lavage especially in multiseptated or intraventricular abscess • Associated repeated procedure 36
  • 37. Indications for craniotomy and abscess excision • Presence of foreign body • Post traumatic/ gas containing abscess • Superficial located abscess with thick membranes • Peripheral abscess resistant to aspiration or antibiotics • Cerebellar abscess • Abscess that results from fistulous communication 37
  • 38. Contraindications for craniotomy with abscess excision • Abscesses in cerebritis stage • Deep seated abscesses in eloquent areas • Multiple abscesses 38
  • 39. Specific Considerations • Multiple abscess(5% -50% )- surgical(aspiration) or medical only/combination • Cerebellar abscess(6-35%) -Posterior fossa craniotomy advised+/- ventriculostomy, however burr hole aspiration has emerged as a satisfactory method • Brainstem abscess-Posterior fossa craniotomy • Tubercular abscess- AntiTb with drainage • Subdural and epidural abscess- surgery(evacuation and membrane excision) plus antimicrobial therapy 39
  • 40. Medical Therapy • Indicated for extremely poor surgical candidates with • Microabscess(<2cm-debatable) • Multiple abscess • Cerebritis stage • Inaccessible localization • Concomitant meningitis, ependymitis • Improvement on antibiotics therapy 40
  • 41. 41
  • 42. Duration of antibiotic • Numerous recommendations • 6-8 weeks IV, followed by 2-3months oral • 12 weeks IV, for medical therapy alone • Post excision- 4 to 6 weeks antibiotics • Triple high dose therapy- 2 weeks IV, followed by 4 weeks oral • 3-12 months antimicrobial for the immunocompromsed 42
  • 43. Radiographic monitoring • Cranial scans weekly during the course of therapy • One week after discontinuation of therapy • Scan one month later • Monthly or bimonthly until radiographic resolution 43
  • 44. Role of Steroids • Controversial • Indications: • Impending brain herniation • Progressive neurological deterioration • Associated massive edema and mass effect • Prolonged use is discouraged 44
  • 45. Role of anticonvulsants • Legg et al advocated 5year course for all patient with brain abscess. • Muzumdar etal recommended discontinuation after 2 years of seizure free, with no epileptic activity on EEG • Also anticonvulsant is recommended for children who develop seizure, most authors recommend providing at least 3 months of prophylaxis if no more seizures have occurred. 45
  • 46. Role of Hyperbaric oxygen • In addition to surgery, hyperbaric oxygen therapy has been reported to be a useful adjunct • More useful in fungal brain abscess • Although no randomized, prospective studies have been performed to assess its efficacy. 46
  • 47. COMPLICATIONS • Reoccurrence(10%) • Focal neurological deficit(30-50%) • Mental retardation • Seizure(70%) • Venous sinus thrombosis • Hydrocephalus • Septicemia • Meningitis • Ventriculitis 47
  • 48. PROGNOSIS • Poor outcome associated with: • intraventricular rupture(80% mortality) • rapid progress prior to hospitalization • coma or stupor, • Initial GCS <12 • Aspergillosis(90%) • Comorbidities(Charlson scale >/2) 48
  • 49. LOCAL EXPERIENCE • 5 cases • M: F=3:2 • Age:4-55yrs • Mortality rate : 40% 49
  • 50. CURRENT TRENDS • 16S Ribosomal sequencing • Emphasis on stereotactic aspiration 50
  • 51. CONCLUSION • Intracranial abscesses are uncommon, serious, life-threatening infections with varied aetiological agents and route of spread. • Its numerous presentation may pose a diagnostic dilemma to the clinician • High index of suspicion, prompt response with appropriate management will help to improve outcome 51
  • 52. REFERENCE • Olorunmoteni OE, Onyia CU, Elusiyan JBE, Ugowe OJ, Babalola TE, Samuel I. Intracranial abscesses in children at Ile-Ife, Nigeria: a case series and review of literature. Childs Nerv Syst. 2020 Aug;36(8):1767- 1771. doi: 10.1007/s00381-020-04529-2. Epub 2020 Feb 8. PMID: 32034520. • Udoh DO, Ibadin E, Udoh MO. Intracranial abscesses: Retrospective analysis of 32 patients and review of literature. Asian J Neurosurg 2016;11:384-91 • Chika Ndubisi,Samuel Ohaegbulam,Wilfred Mezue, Mark Chikani Management of Brain Abscess: Changing Trend and Experience in Enugu, Nigeria. July 2017Nigerian Journal of Surgery 23(2):106 52
  • 53. REFERENCE • Vincent Thamburaj. Textbook of Contemporary Neurosurgey,Vol 1 • Friedman Em, etal.Intracranial complications of sinusitis in children.A sequuela of periapical abscess.Ann Otol Rhinol Laryngol.1982.41-3 • Brook I.Microbiology and treatment of brain abscess. J Clin Neurosci. 2017. 38:8-12 • Management of Brain Abscess. A seminar presentation by Dr Moses Inojie • Muzumdar D, Jhawar S, Goel A. Brain abscess: An overview. Int J Surg. 2011;9:136–44. • Legg NJ, Gupta PC, Scott DF. Epilepsy following cerebral abscess. A clinical and EEG study of 70 patients. Brain. 1973;96:259–68. 53
  • 54. • THANK YOU FOR LISTENING 54