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Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Histologic findings depend on whether the infection is acute or chronic. Early, the abscess is poorly demarcated with acute inflammation and edema, reflecting cerebritis. However, liquefaction occurs over the first 2–3 weeks, followed by organization inside a fibrotic capsule.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Jocelyn A. Luongo, Boris Shapiro, Orlando A. Ortiz, Douglas S. Katz
Cerebritis is a term used to describe an acute inflammatory reaction in the brain, with altered permeability of blood vessels, but not angiogenesis. Cerebritis is the earliest form of brain infection that may then progress to abscess formation, as previously noted. Cerebritis alone can be managed non-surgically with antibiotics [64].
Complications of Rhinosinusitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
In the absence of abscess formation or reduction in visual signs medical management should initially be implemented for the first 24 hours, with frequent monitoring as described previously (Figure 101.5). If there is no significant clinical improvement in the first 24 hours of medical treatment, surgical intervention should be considered. Also, if at any point there is any clinical deterioration, urgent repeat imaging with a view to emergency surgical intervention is likely to be required. For orbital complications, intravenous antibiotic administration should continue until clinical improvement is well established and only then should oral medications be substituted. Evidence for how long oral antibiotics should be continued is limited, though 14 days of culture directed antibiotics is often appropriate. In the early stages of cerebritis, appropriate antibiotic administration can prevent intracerebral abscess formation.35 Once a brain abscess has formed, surgical drainage combined with a prolonged antibiotic course of 4–8 weeks is recommended.29
Paediatric brain abscesses: a single centre experience
Published in British Journal of Neurosurgery, 2019
Samuel Hall, Shirley Yadu, Benjamin Gaastra, Nijaguna Mathad, Owen Sparrow, Ryan Waters, Aabir Chakraborty, Vassilios Tsitouras
Prognosis is dependent on the efficiency of diagnosis and management.8 The gold standard treatment of brain abscesses continues to be aspiration or excision combined with antibiotic therapy.5,9 However the outcome has improved dramatically in recent decades due to improvements in diagnostic techniques and broad-spectrum antibiotics.10,11 The modification of empirical antibiotic regimes to cover anaerobic organisms has also positively influenced outcomes.12 Early diagnosis and prompt use of antibiotic therapy increases prognosis and outcome by preventing the progression from cerebritis to abscess10 and those with a shorter period between symptom onset and surgery have a more favourable prognosis.2 Magnetic Resonance Imaging is more sensitive at diagnosing early cerebritis,10,13 and has increased the prognosis of brain abscess by improving the speed of diagnosis.14 Despite all of these advances abscesses are still a significant cause of morbidity and mortality.4,15
Anti-infective treatment of brain abscess
Published in Expert Review of Anti-infective Therapy, 2018
Jacob Bodilsen, Matthijs C. Brouwer, Henrik Nielsen, Diederik Van De Beek
Drug concentrations may vary within each CNS compartment as has been shown for simultaneous measurements of drug concentrations in the CSF of the ventricular and lumbar spaces [17,18]. Other studies have used anti-infective concentration measurements from brain homogenates as proxies for the extra- and intracellular space, but such results are difficult to interpret. One experimental study in rats showed that concentrations of selected drugs obtained by brain homogenates, CSF concentrations, and brain tissue microdialysis were within a threefold error margin of each other and suggested that CSF concentrations could serve as proxies for extracellular space concentrations [24]. However, neither of the measurements may adequately reflect the drug concentrations in an encapsulated brain abscess with a rich blood supply and a locally disrupted BBB. Consequently, anti-infective concentration measurements of pus obtained at aspiration or excision is the most accurate method to assess intracavitary penetration. For patients with cerebritis, the most relevant parameter is the drug concentration in brain extracellular fluid, for example by brain tissue microdialysis. When data for abscess penetration are lacking, physicians can to some extent rely on studies of penetration of brain tissue or CSF which has been reviewed elsewhere [17].
Imaging of infectious and inflammatory cystic lesions of the brain, a narrative review
Published in Expert Review of Neurotherapeutics, 2023
Anna Cervantes-Arslanian, Hector H Garcia, Otto Rapalino
In the early stage of development (cerebritis), CT imaging may show low-attenuation lesion with mass effect and variable peripheral enhancement compared with uniform ring enhancement with mature abscesses. On MR, infected tissue early on appear as ill-defined T1 iso- to hypointense and T2/FLAIR hyperintense lesions with absent or mild contrast. In later cerebritis, the lesion may be a poorly defined area with central necrosis, local mass effect, and peripheral enhancement. Restricted diffusion may occur [8]. Abscesses show ring enhancement with a T1 hyperintense, T2 hypointense core with surrounding T1 hypointense, T2/FLAIR hyperintense edema, and often demonstrate DWI restriction with low ADC signal [1,9]. See Figure 1.