· A brain abscess is a collection of infectious material within the tissue of the brain. It accounts for less than 2%
· Brain abscesses are rare in immunocompetent people; they are more frequently diagnosed in people who are immunosuppressed as a result of an underlying disease or use of immunosuppressive medications.
· Predisposing conditions (otitis media and rhino sinusitis, intracranial surgery, penetrating head injury, or tongue piercing)
· Organisms causing brain abscess may reach the brain by hematologic spread from the lungs, gums, tongue, or heart, or from a wound or intra-abdominal infection
· Bacteria are the most common causative organisms.
· Prevention: To prevent brain abscess, otitis media, mastoiditis, rhino sinusitis, dental infections, and systemic infections should be treated promptly.
· The clinical manifestations of a brain abscess result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess.
· Headache, usually worse in the morning, is the most prevailing symptom.
· Fever, vomiting, and focal neurologic deficits occur as well.
· Focal deficits such as weakness and decreasing vision reflect the area of brain that is involved.
· As the abscess expands, symptoms of increased ICP such as decreasing LOC and seizures are observed.
Assessment and Diagnostic Findings
· Neuroimaging studies such as MRI or CT scanning identify the size and location of the abscess.
· The MRI or CT scans reveal a ring around a hypodense area.
· Aspiration of the abscess, guided by CT or MRI, is the best method to culture and identify the infectious organism.
· Blood cultures are obtained if the abscess is believed to arise from a distant source. Chest x-ray is performed to rule out predisposing lung infections and an electroencephalogram (EEG) may help localize the lesion.
· Treatment is aimed at controlling increased ICP, draining the abscess, and providing antimicrobial therapy directed at the abscess and the primary source of infection.
· Large IV doses of antibiotics are administered to penetrate the blood—brain barrier and reach the abscess.
· The choice of the specific antibiotic medication is based on culture and sensitivity testing and directed at the causative organism.
· A stereotactic CT-guided aspiration may be used to drain the abscess and identify the causative organism.
· Corticosteroids may be prescribed to help reduce the inflammatory cerebral edema i the patient shows evidence of an increasing neurologic deficit. Antiseizure medications (phenytoin, Phenobarbital) may be prescribed to prevent or treat seizures.
• Nursing care focuses on continuing to assess the neurologic status, administering medications, assessing the response to treatment, and providing supportive care.
• Ongoing neurologic assessment alerts the nurse to changes in ICP, which may indicate a need for more aggressive intervention.
• The nurse also assesses and documents the responses to medications. Blood laboratory test results, specifically blood glucose and serum potassium levels, need to be closely monitored when corticosteroids are prescribed.
• Administration of insulin or electrolyte replacement may be required to return these values to normal or acceptable levels.
• Patient safety is another key nursing responsibility. Injury may result from decreased LOC or falls related to motor weakness or seizures.
· The patient with a brain abscess is very ill, and neurologic deficits, such as hemi paresis, seizures, visual deficits, and cranial nerve palsies, may remain after treatment.
• Seizures are common sequel. The nurse must assess the family's ability to express distress at the patient's condition, cope with the patient's illness and deficits, and obtain support.