Subdural brain abscess
Subdural brain abscess (internal pachymeningitis) - is the rarest otogenic complication. A 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 the cranial cavity.
A very rare localization of subdural brain abscess in a patient ear opposite hemisphere. This is due to the 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.
Symptoms and course of subdural brain abscess
Starting at high temperature (up to 38–39 °C), clinically 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 a very frequent combination of the subdural abscess with other intracranial complications explain the exceptional difficulty of diagnosis of a brain abscess, which is usually detected at surgery or postmortem autopsy. Suspect on 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:
- MRI of the brain
- MR angiography
- CT of the brain
- CT angiography
- based on data from the puncture of the brain
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 by 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.).