Brain Abscess

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 Or it could be hematogenous.

00:19 Acute bacterial endocarditis.

00:22 Or cyanotic congenital heart defects.

00:25 So anyone of these type of presentations could then result in eventual brain abscess.

00:32 Spreading.

00:34 Spreading.

00:37 Clinical features: Headache, nausea with vomiting, papilledema, focal neurologic, pretty nonspecific.

00:44 Elevated CSF, WBC count, and here we go, ring enhancing lesion on CT or MRI.

00:51 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.

00:59 Technically, two.

01:01 Toxoplasmosis, AIDS patient, immunocompromised.

01:04 Most common CNS infection in an AIDS patient, toxoplasmosis.

01:09 What if serology comes back to be negative? You still move forward with treatment because your patient has AIDS.

01:15 How long do you give therapy? Lifelong therapy.

01:18 Toxo.

01:19 Then we looked another ring enhancing lesion during active, active, infection with neurocysticercosis.

01:27 It could be ring enhancing.

01:28 But I told you most common presentation would be a calcified cyst in the brain and then we have brain abscess.

01:36 And here, we have ring enhancing lesion.

01:38 Pathogenesis, well, we’ll just walk through how maybe a patient has endocarditis.

01:44 Maybe there is a direct seeding, so on and so forth, hematogenous spread.

01:48 Edema, ring enhancing lesion, and an abscess core.

01:52 So in other words, this time, we don’t have calcifications.

01:56 So therefore, we have a ring with an abscess core.

02:01 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? It will be liquefactive necrosis.

02:14 Because neutrophils are destroying everything in its path.

02:18 Brain abscess.