Brain abscess

A stove Encephalitis is a at least one point (lat. focus = cooking ) occurring inflammation of the brain. This is usually caused by bacteria, rarely by fungi or other pathogens and thus also referred to as septic stove encephalitis.

• 4.1 infectious source
• 4.2 antibiotics
• 4.3 Treatment of the underlying disease

Formation

For the emergence of a stove encephalitis pathogen must reach the brain. There are various ways:

• Direct Keimeinschleppung through open traumatic brain injury (TBI )
• From continuing headed inflammation ( sinusitis, mastoiditis ) or from the tooth ( odontogenic )
• Einschwemmung with the blood (septic stove encephalitis, see below)
• By infection of an implant ( Liquorableitung )

The risk is increased with a weakening of immunity, as due to congenital or acquired factors ( trauma, acute infectious disease, cancer, AIDS) may be caused.

Molding

Brain abscess

The body's natural defense ( immunity ) leads to a melting of the highly infected tissue and differentiating it from the surrounding tissue. This creates an abscess. In this process, it comes to the increase in volume ( mass ), which can lead (eg herniation ) due to the limited bony cranial cavity pressure rise rapidly with severe complications.

Septic - embolic stove encephalitis

By spreading of infected thrombi, there is a combination of ischemic stroke and concurrent inflammation. The course is often due to the infection of the no longer perfused brain tissue (where the absence of blood flow with minimal immunity ) and bleeding into the infarct in many cases unfavorable.

The starting point is almost always a bacterial inflammation of the inner heart wall ( endocardium ) and there especially the heart valves ( endocarditis).

Septic metastatic stove - encephalitis

In presence of bacteria in the flowing blood ( septicemia ) can occur pathogen spread in the brain. This is possible only in the context of a severe inflammatory illness or mostly sepsis. The further development is mainly determined by the underlying infection.

Diagnostics

First, an imaging examination is required, which is done mostly by means of contrast-enhanced computed tomography or magnetic resonance imaging. Here, the flammable range, the surrounding edema and accumulation of the contrast agent can be seen in most cases.

For further therapy after all, is the detection of the pathogen of major importance. This is by microbiological examination of cerebrospinal fluid ( see spinal tap ) or blood cultures or possible the oven (after neurosurgical rehabilitation or at least puncture) possible. It is significant in addition to knowledge of the pathogen and its drug sensitivity ( antibiogram ).

Then possibly the origin of the pathogen must be sought. This are often a chest CT and abdomen ( with contrast medium ) or the sinuses necessary. Furthermore, echocardiography has a high importance.

Therapy

Infectious source

Wherever possible, the inflammatory cooker should be removed by surgery. For this purpose, neurosurgery is responsible.

However, this procedure is not always possible, for example, if the focus is in a very important region of the brain (eg, language center or brain stem ). Then, only a drug treatment (see below) is possible, but then must be performed may considerably longer.

Antibiotics

After extraction of material for microbiological examination (see above), treatment with antibiotics is under suspicion on a stove encephalitis required. Treatment is initially with a broad spectrum (eg cephalosporin 3rd generation staphylococcal effective penicillin). After determination of the susceptibility can be converted to a targeted therapy (usually with less broad spectrum).

In cases of suspected fungal infection needs to be treated (eg, amphotericin B ) in accordance with an additional antifungal agent.

Treatment of the underlying disease

Depending on the starting point of the infection, the treatment of the underlying disease should not be neglected, especially in a further unescorted from ear or sinus brain abscess this primary focus is immediate surgery to clean up. In endocarditis may be necessary, for example, insertion of a prosthetic heart valve. Other collections of pus (eg, infected wounds, Zahnwurzelabszess, Osteomyelitits, etc.) should be rehabilitated surgically if possible.

The treatment of sepsis is usually possible only in an ICU.

Complications

The most common complication is the mass with increase in intracranial pressure. This may be necessary, in particular a CSF drainage or in some cases a craniectomy again neurosurgical interventions.

Further complications are inflammation of blood vessel walls (vasculitis ) and brain infarcts both by vascular occlusion as well as by hemorrhage.

Forecast

The further development of the patient first depends on the conditions of the patient:

• General condition (age, pre-existing conditions, etc.)
• Underlying disease ( endocarditis, TBI)
• Comorbidities (diabetes mellitus, AIDS, etc.)

However, these are hardly influenced.

Furthermore, the medical care is important:

• Availability of disciplines (radiology, neurology, neurosurgery, intensive care )
• Availability of diagnostics (laboratory, computer, microbiology )
• Early start of a consistent treatment (antibiotics and surgery)

These factors can be influenced decisively may already posting to a suitable hospital to be.