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Subdural brain abscess

Subdural brain abscess

Subdural brain abscess (internal pachymeningitis) - is the mostly rare otogenic complication. Subdural abscess occurs predominantly in chronic purulent otitis media. Most often, subdural brain abscess occurs in the middle cranial fossa, but is also found in other areas of cranial cavity.

A very rare localization of subdural brain abscess in a patient ear opposite hemisphere. This is due to drift of metastatic disease. In the same way and there are multiple subdural brain abscesses. The inflammatory process can develop the type of subdural brain abscess, without suppuration, but more often takes place pyocele underneath the dura.

Subdural brain abscess precedes extradural process. Subdural brain abscess is caused by the breakthrough of pus through the dura mater, or the spread of infection through the vessels. Usually in the damage in the inflammatory process involved all the lining of the brain and brain surface convolutions.

Pus, destroying soft and arachnoid membrane, accumulate in the furrows of the cerebral cortex and usually melts the surface layer of the cortex. A large gathering of pus, it compresses the brain, and sometimes shifts the opposite side of the brain. Extremely rare for a subdural brain abscess observed breakthrough of pus through the dura mater and bone in the middle ear cavity and even the skin.

Axial computed tomography (CT) of the head. Computed tomography (CT) of the temporal bone reveals the impairment of the middle ear, mastoid and infralabyrinthine space.

Symptoms and course of subdural brain abscess

Starting at high temperature (up to 38–39 °C), clinical subdural abscess is characterized mainly by the severity of a brain, the meningeal symptoms. With a subdural brain abscess frequent focal neurological symptoms due to compression or swelling of the cerebral cortex.

 

Diagnosis of subdural brain abscess

Specified circumstances, along with very frequent combination of subdural abscess with other intracranial complications explain the exceptional difficulty of diagnosis of an brain abscess, which is usually detected at surgery or postmortem autopsy. Suspect and subdural brain abscess can sometimes be a combination of pronounced meningeal symptoms with small changes in the cerebrospinal fluid.

Magnetic resonance imaging (MRI) performed for suspected subdural brain abscess.

With a subdural brain abscess successfully applied auxiliary diagnostic methods in the form:

Axial T1-weighted brain MRI. Magnetic resonance imaging (MRI) of the brain with gadolinium reveals meningitis and contrasting rim around the large-sized lesions of brain tissue.

Axial brain magnetic resonance imaging (MRI) in FLAIR mode corresponds to the pattern of brain abscess.

Axial magnetic resonance imaging (MRI) of the brain in the ADC (apparent diffusion coefficient) mapping mode corresponds to the picture of the brain abscess.

 

Treatment of subdural brain abscess

Treatment of subdural brain abscess is the corresponding operation on the temporal bone (if it has not previously been made) and the drainage of the abscess with complete its drainage. Postoperatively, antibiotics are prescribed in accordance with antibiotic sensitivity and sulfonamides. Antibiotics were administered intramuscularly as well as locally.

To combat the toxicity in the subdural abscess introduce sufficient quantities of liquid based electrolyte balance and osmotic pressure (excessive drinking, polyionic solutions). At the same time as clinically indicated dehydration carried by the appointment of diuretics (furosemide or Lasix, diakarb, etc.).