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Brain Abscess

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BRAIN ABSCESS
Definition
-an infection in the brain that is encapsulated (confined within its own area) and localized to one or more areas inside of the brain
-a collection of immune cells, pus, and other material in the brain, usually from a bacterial or fungal infection
-occur in all children, but are more common in young school-aged children and occur twice as often in males than in females
-usually associated with congenital heart disease in young children

Etiology
-Direct extension of cranial infections (osteomyelitis, mastoiditis, sinusitis, subdural empyema)
-Penetrating head wounds (including neurosurgical procedures) -Hematogenous spread (in bacterial endocarditis, congenital heart disease with right-to-left shunt, or IV drug abuse)

Signs and Symptoms * FRONTAL LOBE: * Hemiparesis * Aphasia * Seizure * Frontal headache * TEMPORAL LOBE: * Localized headache * Changes in vision * Facial weakness * Aphasia * CEREBELLAR ABSCESS: * Occipital headache * Ataxia (inability to coordinate movements) * Nystagmus (rhythmic, involuntary movements of the eye) * In babies and younger children: * Fever * A full or bulging fontanelle (soft spot located on the top of the head) * Sleepiness or fewer alerts than usual * Increased irritability * High-pitched cry * Poor feeding * Projectile vomiting * Seizures * In older children: * Fever * Complaints of severe headaches * Nausea and vomiting * Changes in personality or behavior * Changes in speech * Problems walking * Increased movement in the arms or legs (spasticity) * Seizures

Pathophysiology

Diagnostic Exam * Blood tests * X-ray * Magnetic resonance imaging (MRI) * Computerized tomography scan (CT or CAT scan) * Urine and stool tests * Sputum culture * Lumbar puncture (spinal tap) * Electroencephalogram (EEG) * Intracranial pressure monitoring (ICP)

Medical Management * Antibiotics(cefotaxime, orceftriaxone) – to penetrate the blood-brain barrier and reach the abscess * Cortecosteroids(dexamethasone) – to help reduce the inflammatory cerebral edema if the patient shows evidence of an increasing neurologic deficit * Antiseizure(phenytoin, phenobarbital) – to prevent or treat seizures * Stereotactic CT-guided aspiration – to drain the abscess and identify the causative organism

Surgical Management * Surgical aspiration or removal of brain abscess - performed for patients that are resistant to medical treatments Nursing Management * Continuing to assess the neurologic status and alerts for changes in ICP – indicate a need for more aggressive intervention * Assess and documents the responses to medications * Need to be closely monitored the blood glucose and serum potassium levels when corticosteroids are prescribed * Administration of insulin/electrolyte replacement – required to return these values to normal or acceptable levels * Provide patient’s safety – injury may result from decreased LOC or falls related to motor weakness or seizures * Assess the family’s ability to express distress at the patient’s condition * Cope with the patient’s illness and deficits * Obtain support

Prevention * You can reduce the risk of developing a brain abscess by treating any disorders that can cause them. Have a follow-up examination after infections are treated. * Some people, including those with certain heart disorders, may receive antibiotics before dental or urological procedures to help reduce the risk.

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