Chapter 43 - Brain and Spinal Cord Abscess

Abstract

This chapter presents a discussion on the clinical aspects of the brain and spinal cord abscess. Brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. Brain abscesses can be classified according to the route of infection—contiguous spread of an adjacent infection, hematogenous seeding from a distant focus, and direct inoculation of pathogens or facilitation of their entry into the brain by trauma or neurosurgical procedures. Frequent contiguous infections predisposing for brain abscess are otitis media or mastoiditis and paranasal sinusitis. Infrequent causative adjacent infections are those of the teeth, the skull, or the scalp. Very rarely, a brain abscess can result from an infection within the subarachnoid space. The site of the primary infectious focus often determines the location of the abscess. Thus, otogenic abscesses are frequently located in the cerebellum or temporal lobe. Abscesses due to paranasal sinusitis or odontogenic infections are often located in the frontal lobe. The discussion on principles of therapy includes surgery of brain abscess, medical therapy, which includes antibiotics, anticonvulsants, and corticosteroids. The chapter also discusses prophylaxis of brain abscess, subdural empyema, epidural abscess, spinal epidural abscess, and others.