Brain Abscess

Question 1

Brain abscess can spread from_____ infection in the ___,_____, or _____.

Answer 1

contiguous

sinuses, mastoid air cells, or otitis media

Question 2

Further than contiguous, also via ____ can allow infected material to lodge in the brain. Like these 2 sources: _______

Answer 2

bacteremia

Pneumonia and endocarditis cause bacteremia, which causes brain abscess

Question 3

CxFx

Answer 3

headache, nausea, vomiting, fever, seizures, and focal neurological findings.

Question 4

Cx Presentation is somewhat nonspecific and there is no way to distinguish a brain abscess from ____without a ___. why

Answer 4

cancer
biopsy

Cancer can give a fever.

Question 5

The best initial test is

Answer 5

a head CT or MRI.

shows a “ring” or contrast enhancing lesion that will likely have surrounding edema and mass effect.

Question 6

The most accurate test is

Answer 6

a brain biopsy.

Question 7

CSF would be

Answer 7

unlikely to be helpful even if it were obtained, and LP is contraindicated because of the possibility of herniation.

Question 8

Abscesses can be from the following organisms

Answer 8

staphylococci, streptococci, gram-negative bacilli, and anaerobes.
frequently mixed

Question 9

Treatment while waiting for the results of culture

Answer 9

Empiric therapy with penicillin plus metronidazole plus ceftriaxone (or cefepime)

AMBOSS: third-generation cephalosporin PLUS metronidazole with/without vancomycin)

Question 10

________ can be used instead of penicillin, particularly if ____

Answer 10

Vancomycin

there has been recent neurosurgery and the risk of staphylococci, especially resistant staphylococci, is greater.

Question 11

What additional medical management would be useful?

Answer 11

• Intracranial pressure management: e.g., dexamethasone

- Seizure prophylaxis (e.g., anticonvulsants)