Info
🌱 來自: Huppert’s Notes
Brain abscess🚧 施工中
Brain abscess
• Pathophysiology: Complication of otitis media, sinusitis, odontogenic infection, post-surgical infection
• Clinical features: Often non-specific features, including fever, headache, and/or focal neurologic deficits. Classic triad of all three is present in only ~20% of cases.
• Pathogens: Streptococcus spp. and Staphylococcus spp. are the most frequent organisms. Often polymicrobial infections (~40%) that contain both aerobic and anaerobic organisms.
• Diagnosis: Brain MRI. Needle aspiration and surgical excision are possible options for making a microbiologic diagnosis of the causative organism(s).
• Treatment:
- Empiric antibiotics: vancomycin + ceftriaxone 2 g IV q12 hrs + metronidazole 500 mg IV/PO q8 hr
- Immediate neurosurgical evaluation for consideration of neurosurgical excision or drainage
- Consider adjunctive glucocorticoids if mass effect seen on imaging, but neurosurgical consultation should be used to make this decision
Spinal epidural abscess
• Pathophysiology: Bacteria can spread from infected vertebrae or nearby soft tissues, or via hematogenous spread
• Clinical features:
- Presentation is often slow and insidious with symptoms lasting weeks to months, but can be more acute with aggressive organisms like S. aureus
- Back pain is the most common symptom. Fever is variably present. ~50% of patients have a neurologic symptom (e.g., radiculopathy, motor or sensory dysfunction), which often develop later in the disease course.
• Pathogens: Streptococcus spp. and Staphylococcus spp.
• Diagnosis: Spinal MRI
• Treatment:
- Empiric antibiotics with vancomycin IV + ceftriaxone IV 2 g q12 hr. Ceftriaxone can be substituted for an anti-pseudomonal beta-lactam, such as cefepime 2 g IV q8 hr.
- Immediate neurosurgical evaluation and consideration of surgical drainage