Dr. Ali Omar Saadoon Lec 2CNS Infection#232Brain abscess 8% of all intracranial space-occupying lesions%2 (most industrialized nations)Risk factors1.pulmonary abscess2. AV fistulas,3. congenital cyanotic heart disease,4.immune compromise,5.chronic sinusitis/otitis,6.dental proceduresThe microorganism may reach the brain by different mechanisms:1. Hematogenous spread from remote reservoir of infection( most common) Adults; chest is the most common (lung abscess,bronchiectasis,empyema) children; congenital cyanotic heart disease with R to L shunt Immunosuppression (AIDS-toxoplasmosis)2. Contiguous site of infection (infected sinus,naso/oropharynx) e.g. otitismedia,mastoiditis,sinusitis,osteomyelitis,dental abscess.3. Direct inoculation from penetrating trauma or during neurosurgical procedures.(trauma,iatrogenicpost operative, congenital defect.dermal sinus In 20% of patients, no cause can be identifiedSurgery 1The responsible microorganism Otitis media : anaerobic streptococci, Haemophilus and Gram-negative anaerobic Sinusitis: streptococcus milleri and staphylococcus Traumatic: staphylococcus Hematogenous spread : various organism are involvedClinical features features of raised intracranial pressure Seizure meningeal irritation focal signs rapid progressionSystemic features of infection are frequently absentInvestigation leucocytosis, raised ESR, and C-reacti ...
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