Consultation with the specialist. Brain abscess.

Abstract

1. D. Douglas Cochrane, MD* 1. 2. *Division of Neurosurgery, Section of Surgery, British Columbia’s Children’s Hospital; Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. Brain abscess is relatively uncommon in clinical practice in 1999, yet it remains a serious and life-threatening disease among children and adolescents despite technological advances made in the second half of this century. These advances include aggressive treatment of primary infections, detailed understanding of causative organisms, and improved antibiotics and sensitivity testing techniques. Neuroradiologic imaging, specifically computed tomography (CT), now can reveal the infective process before an abscess forms and can demonstrate the effects of both the primary infection and the treatment accurately. To manage the patient who has a brain abscess with minimal morbidity and mortality, aggressive medical and surgical therapies, singly or in combination, are required. Brain abscess results from seeding of microorganisms into an area of injured cerebral parenchyma by direct spread of infection from soft tissues of the neck and face, sinuses, or cranium or following bacterial implantation resulting from penetrating cranial wounds or operative interventions. Hematogenous seeding from a remote focus also may result in abscess formation. The development of cerebral infection depends on the number of organisms to which the patient is exposed and their virulence, the immunologic competence of the patient, and the timeliness of clinical diagnosis and treatment. Brain abscess is a focal, intracerebral infection evolving from an area of cerebritis into a collection of purulent material enveloped in a vascularized capsule. The most common cause of intracerebral abscess formation is direct or indirect spread from infection in paranasal sinuses, middle ear, and teeth in children and teenagers. Frontal, ethmoid, sphenoid, and maxillary sinusitis give rise to abscess formation in the frontal (Fig. 1⇓). and parietal lobes; mastoiditis results in temporal or cerebellar abscess formation. Metastatic spread from remote foci of infection remains an important pathogenic mechanism in children and adults who have congenital cardiac or pulmonary right-to-left shunts as …