Brain Abscess

Description

• A brain abscess is a collection of infectious material within the tissue of the brain.
• Bacteria are the most common causative organisms. An abscess can result from intra-cranial surgery, penetrating head injury, or tongue piercing.
• Organisms causing brain abscess may reach the brain by hematologic spread from the lungs, gums, tongue, or heart, or from a wound or intra-abdominal infection. It can be a complication in patients whose immune systems have been suppressed through therapy or disease.

Prevention

• To prevent brain abscess, otitis media, mastoiditis, rhinosinusitis, dental infections, and systemic infections should be treated promptly.

Clinical Manifestations

• Generally, symptoms result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess.
• Headache, usually worse in morning, is the most prevailing symptom.
• Fever, vomiting, and focal neurologic deficits (weakness and decreasing vision) occur as well.
• As the abscess expands, symptoms of increased intracranial pressure (ICP) such as decreasing level of consciousness and seizures are observed.

Assessment and Diagnostic Methods

• Neuroimaging studies such as MRI or CT scanning to identify the size and location of the abscess
• Aspiration of the abscess, guided by CT or MRI, to culture and identify the infectious organism
• Blood cultures, chest xray, electroencephalogram (EEG)

Medical Management

• The goal is to eliminate the abscess.
• Treatment modalities include antimicrobial therapy, surgical incision, or aspiration (CTguided stereotactic needle).
• Medications used include corticosteroids to reduce the inflammatory cerebral edema and antiseizure medications for prophylaxis against seizures (phenytoin, phenobarbital).
• Abscess resolution is monitored with CT scans.

Nursing Management

• Nursing interventions support the medical treatment, as do patient teaching activities that address neurosurgical procedures.
• Patients and families need to be advised of neurologic deficits that may remain after treatment (hemiparesis, seizures, visual deficits, and cranial nerve palsies).
• The nurse assesses the family’s ability to express their distress at the patient’s condition, cope with the patient’s illness and deficits, and obtain support.

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