Encephalopyosis

Brain abscesses - encapsulated accumulation of pus in the substance of the brain, can occur through contact with infection (with purulent otitis, osteomyelitis, mastoiditis, sinusitis), hematogenous metastasis from a distant source (lung, oral cavity, skin, bone, colon, heart) or as a direct result of infection (with a brain injury or surgical intervention). Children over 60% of brain abscess associated with congenital heart disease, accompanied by the release of blood from right to left.

The causative agent of most streptococci are more rarely bacteroides, enterobacteria, staphylococci, fungi, in patients with low immunity - toxoplasma, Knockard, cryptococcus, Listeria. Predisposing factors are diseases that reduce immunity: diabetes mellitus, malignant novoo6razovaniya (including leukemia, lymphoma), AIDS, immunosuppressive therapy, chronic liver disease and kidney failure. Get sick more often face a young age.

For an abscess of the brain characterized by triad of symptoms, including headache, fever, focal neurological symptoms (eg, hemiparesis, aphasia or hemianopsia). However, in full triad occurs not in all patients. Thus, the increase in body temperature observed only in half of cases, usually before the formation of an abscess capsule. After the formation of a capsule (usually by the end of 2 weeks), general manifestations of infection are reduced. Less than half the patients marked meningeal signs, seizures, depression of consciousness, revealed congestion of the optic nerve.

Diagnosis is confirmed by computer and magnetic resonance imaging. Displacement of midline structures of the brain can be detected using ehoentsefaloskopii. Lumbar puncture for suspected brain abscess is contraindicated. To identify the source of infection is carried out X-ray skull and chest, echocardiography, ultrasound of abdominal organs, bacteriological examination of blood.

Surgical treatment. Mandatory appointment of antibacterial agents. Typically use a combination of third generation cephalosporins (ceftriaxone or cefotaxime) with the antibiotic acting on Staphylococcus (eg, vancomycin or oksitsillinom) and an antibacterial agent acting on anaerobes (metronidazole). In the early stages of abscess or small (up to 3 cm), multiple or inaccessible to surgical intervention abscesses (eg, brain stem) antibiotic therapy may be the only treatment option