Brain Abscess

by Carlo Raj, MD

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    00:01 Here, we have brain abscess.

    00:03 With the brain abscess, acute focal suppurative infection of brain parenchyma.

    00:09 What does suppurative mean to you? Bacterial.

    00:13 Under brain abscess, there might be direct seeding.

    00:16 Local extension, meaning to say that you have a type of infection taking place down in the mastoiditis or sinusitis.

    00:24 Or it could be hematogenous.

    00:25 Acute bacterial endocarditis.

    00:29 Or cyanotic congenital heart defects.

    00:32 So anyone of these type of presentations could then result in eventual brain abscess.

    00:39 Spreading.

    00:40 Spreading.

    00:43 Clinical features: Headache, nausea with vomiting, papilledema, focal neurologic, pretty nonspecific.

    00:50 Elevated CSF, WBC count, and here we go, ring enhancing lesion on CT or MRI.

    00:58 So now let’s step back for one second and at least, at least, review the three different ring enhancing lesion that we’ve seen.

    01:05 Technically, two.

    01:07 Toxoplasmosis, AIDS patient, immunocompromised.

    01:11 Most common CNS infection in an AIDS patient, toxoplasmosis.

    01:16 What if serology comes back to be negative? You still move forward with treatment because your patient has AIDS.

    01:22 How long do you give therapy? Lifelong therapy.

    01:25 Toxo.

    01:26 Then we looked another ring enhancing lesion during active, active, infection with neurocysticercosis.

    01:33 It could be ring enhancing.

    01:35 But I told you most common presentation would be a calcified cyst in the brain and then we have brain abscess.

    01:43 And here, we have ring enhancing lesion.

    01:45 Pathogenesis, well, we’ll just walk through how maybe a patient has endocarditis.

    01:50 Maybe there is a direct seeding, so on and so forth, hematogenous spread.

    01:55 Edema, ring enhancing lesion, and an abscess core.

    01:59 So in other words, this time, we don’t have calcifications.

    02:02 So therefore, we have a ring with an abscess core.

    02:07 What does an abscess core mean to you? Neutrophils, right? And what does that abscess core mean to you apart from neutrophils coming in? What kind of necrosis is this? What if there is no identification of structure of that organ? It will be liquefactive necrosis.

    02:26 Because neutrophils are destroying everything in its path.

    02:30 Brain abscess.

    02:32 Our topic now brings us to encephalitis.

    02:34 Let me make sure that we’ve organized our thoughts before we move on.

    02:39 Up until this point, we have pretty much looked at meningitides, CNS infections, and now we are dealing with infection of the brain parenchyma.

    02:51 Picture that.

    02:53 Confusion, delirium, focal neurologic seizures and coma.

    02:57 Let me ask you something.

    02:59 If your patient has meningitis, how likely is it that your patient may have seizures if it was strictly meningitis? Maybe, not necessarily.

    03:10 But now, what if you have a spreading into the brain, behaving as space-occupying lesion? There’s every possibility that seizures might be taking place.

    03:22 Now, the infections, they come into the following categories: Arboviruses, including your St. Louis, eastern/western equine, West Nile virus.

    03:33 Enteroviruses.

    03:34 And where we will be spending time with will be HSV-1 herpes.

    03:40 If your patient is in a state of immunocompromised, maybe cytomegalo, EBV, or even perhaps varicella-zoster.

    03:49 What’s my topic? Encephalitis.

    03:51 And you’ll notice for the most part, these are viruses that are commonly found as etiologies.

    About the Lecture

    The lecture Brain Abscess by Carlo Raj, MD is from the course CNS Infection—Clinical Neurology.

    Included Quiz Questions

    1. Brain abscess
    2. Subarachnoid hemorrhage
    3. Tuberculosis
    4. Toxoplasmosis
    5. Neurocysticercosis
    1. Liquefactive necrosis
    2. Fibrinoid necrosis
    3. Coagulative necrosis
    4. Caseous necrosis
    5. Fat necrosis
    1. Yellow fever encephalitis
    2. St. Louis encephalitis
    3. Lyme disease
    4. Western Equine encephalitis
    5. Japanese encephalitis

    Author of lecture Brain Abscess

     Carlo Raj, MD

    Carlo Raj, MD

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