Headache associated with central nervous system infection
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby in Headache in Clinical Practice, 2018
The signs and symptoms of a brain abscess depend on the location of the abscess and the amount of mass effect it produces. Headache, often hemicranial, is the most common presenting symptom, but an abscess can present with a seizure.84,85 Focal neurologic signs and altered mental status are common.83,86 Signs of an antecedent infection, such as otitis media, sinusitis, a dental infection, or endocarditis, may be present. Fever and leukocytosis are less likely to be present. Nausea and vomiting often begin a week after headache onset.83 These symptoms may result from increased intracranial pressure, although less than half of patients have papilledema at presentation.83,87 With a cerebellar abscess, the headache is often suboccipital and there is associated cervical pain and rigidity.24 In 1893, Sir William Macewen described the successful treatment of brain abscess by surgical drainage. The development of antibiotics, advances in neurosurgical techniques, and the use of CT scanning and MRI have all contributed to the significant reduction in mortality that has occurred.83,89
Management of phaeohyphomycosis
Mahmoud A. Ghannoum, John R. Perfect in Antifungal Therapy, 2019
For a single brain abscess, some form of surgical debridement is probably necessary for consistent cure. In this body site, complete surgical removal of a brain abscess that is ideal may not be possible without serious consequences, but even some careful debulking of the lesion may be helpful in reducing the burden of fungi prior to systemic antifungal therapy. Of course, it is possible that surgery might spread the infection to other tissue planes, but it is likely that debulking the mass of fungi far outweighs any concern about infection spread within the brain. Furthermore, all brain abscesses are accompanied by medical treatment with antifungal agents no matter what the extent of surgery. Although occasionally medical therapy alone for brain abscesses has been successful, there are many failures without a combined surgical/medical approach for brain abscesses; therefore, we encourage the combination approach.
Patty
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
As we have seen in a previous e-case (4e-5), an infectious disease can produce a confusional state leading to coma. For example, bacterial meningitis caused by pneumococcus is a well-described complication in individuals with chronic alcohol abuse. It should be noted, however, that acute bacterial meningitis would have evolved over a period of one or two days, as a rule, and would have been accompanied by fever and neck stiffness, neither of which was manifested by our patient. The one-week time course would certainly be consistent with viral encephalitis, but the absence of fever would not. A brain abscess could evolve over several weeks, sometimes in the absence of an obvious fever, but there would probably have been prominent unilateral symptoms and signs such as epileptic seizures and hemiparesis; papilledema would also have been likely had the patient proceeded to a comatose state. Thus, a brain abscess is unlikely.
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
Brain abscess is defined as an area of encapsulated pus within the brain parenchyma that can be caused by bacteria, mycobacteria, fungi, and parasites. Although rare, it has a case fatality rate of 10% and approximately 30% of survivors are left with neurological deficits [1]. The first successful treatment by neurosurgery was described by Scottish surgeon William MacEwen in 1893, but major improvement was only reached after the introduction of anti-infective therapy [2,3]. Further advances were also made with the introduction of computed tomography (CT), stereotactic neurosurgery, and magnetic resonance imaging including diffusion weighted imaging [4–6]. Nonetheless, treatment remains challenging involving both neurosurgery and long-term anti-infective therapy and a multidisciplinary approach consisting of neurosurgeons, infectious disease specialists, microbiologists, neurologists and radiologists is essential. The long-term anti-infective treatment may be particularly difficult considering the requirements to antimicrobial spectrum and pharmacokinetic profile, risks of toxicity and side effects, psychological strain on patients associated with long-term treatment and health-care costs. Here, we review the anti-infective treatment of brain abscess.
Brain metastasis or nocardiosis? A case report of central nervous system Nocardiosis with a review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Hojin Sun, Mariam Goolam Mahomed, Jaimin Patel
A brain abscess is a collection of pus within the brain parenchyma that can result from surgery, trauma, infection, direct inoculation, hematogenous spread from a different site, or from contiguous spread [6]. The incidence of brain abscesses can be up to 8% of all intracranial masses in developing countries and 1% to 2% in developed countries [7]. CNS nocardiosis often presents as a single abscess or multiple brain abscesses, with locations typically being supratentorial. These abscesses have a higher mortality rate than other etiologies of brain abscesses. Abscesses due to CNS nocardiosis result in mortality rates of 20% in immunocompetent patients and 55% in immunocompromised patients, with mortality rates up to 66% if multiple abscesses are present; mortality rates due to other brain abscesses are as low as 5% to 10% [8].
Hypervirulent Klebsiella Pneumoniae, an Emerging Cause of Endogenous Endophthalmitis in A French Center: A Comparative Cohort Study
Published in Ocular Immunology and Inflammation, 2023
Jean-Philippe Martellosio, Nabil Gastli, Rebecca Farhat, Asmaa Tazi, Pierre Duraffour, Benjamin Rossi, Etienne Canouï, Caroline Morbieu, Annick Billoët, Luc Mouthon, Claire Poyart, Antoine Brézin, Paul Legendre
This study outlines for the first time the high proportion of central nervous system involvement in KP EE patients (four out of eight patients), including three diagnosed with cerebral MRI and one with lumbar puncture. Cerebral MRI showed cerebral abscesses in three out of four patients who underwent this exam, whereas cerebral CT scan did not detect any brain abscess. Only two patients had neurological symptoms, one of whom had a lumbar puncture showing meningitis. Therefore, cerebral MRI should be systematically performed in the case of KP EE, as it may modify treatment, including duration and route of administration of antibiotics. In case of neurological symptoms, a lumbar puncture should also be obtained.
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