Brain accesses and other infections Flashcards Preview

Clinical Pathology > Brain accesses and other infections > Flashcards

Flashcards in Brain accesses and other infections Deck (17):
1

What is a brain abcess?

Focal supportive process within brain parenchyma (i.e. pus in substance of the brain)

2

What are the main cause of brain accesses?

Usually mixed bacterial (polymicrobria)

Streptococci e.g. streptococcus anginosus (pus forming)

Staphylococcus
aureus

Gram negative enteric bacteria e.g. E coli, pseudomonas

Anaerobes

Other e.g. fungi, TB

3

What are the mechanisms by which brain accesses can come about?

Direct spread from "continuous" suppurative focus e.g. ear***, sinus, teeth

Haematogenous spread from distant sources e.g. endocarditis, brochioectasis

Trauma e.g. skull fracture

Cryptogenic (no focus e.g. TB)

4

What are the clinical presentations of brain accesses?

- Headache**
- Focal Neurological defects (30-50%)
- confusion/reduced GCS
- Fever (less than 50%)
Nausea, vomiting)
- Dizziness/seizures
- Neck stiffness
- Papilloedema/Coma

5

How do you manage brain accesses?

Brain drainage - reduce IC pressure, enhance diagnosis and treatment i.e. focus antibiotics

6

Give some examples of antibiotics that will penetrate intracranial pus?

- Beta lactams e.g. benzyl Penecillin
Ampicillin

- Cephasporins e.g Cefuroxime, cefotaxime and ceftazidime (3rd gen good against pseudomonas - otitis media)

7

What are sinugenic and odontogenic accesses?

Come from SINUSES and TEETH

8

What are orogenic accesses?

Comes from EAR

9

What are the complications of brain accesses?

- Coning
- Increased IC pressure
- Mass effect
- Rupture, causing ventriculitis

10

What is a subdural empyema?

Infection between dura and arachnoid mater

11

What is the pathogenesis of subdural empyema?

Spread of infection from SINUSES (Usually), middle ear, mastoid or distant site (haematogenous)

Also following surgery e.g. staph aureus

12

What are the causes of subdural empyema?

Polymicrobrial - depends on pathogenesis and location

13

What is the clinical presentation of subdural empyema?

Headache
Fever
Focal neurological Defects *
Confusion/reduced GCS
Seizure
Coma

14

What is the management of subdural empyema?

Urgent surgical drainage of pus, antimicrobial agents

15

What are ventriculoperitoneal (VP) shunts and External ventricular drains (EVD)?

Devices that monitor IC pressure and drain excess CSF

16

What is the relevance for EVD and VP shunts?

Can become infected causing ventriculitis

17

What are the causative organisms the cause infections associated with plastic devices?

Coagulase negative staph
(skin flora)

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