What's the treatment for a brain abscess?
The treatment includes lowering the increased intracranial pressure and starting intravenous antibiotics (and meanwhile identifying the causative organism mainly by blood culture studies). Surgical aspiration or removal of brain abscess are performed for patients that are resistant to medical treatments.
Cerebral abscess is a medical emergency. Intracranial pressure may become high enough to cause death. Hospitalization is required until the condition is stabilized. Life support may be required in some cases.
Medication, not surgery, is advised for multiple abscesses, a small abscess (less than 2 cm), an abscess deep within the brain, an abscess accompanied by meningitis, the presence of shunts in the brain (for hydrocephalus), or an underlying disease that makes surgery dangerous (debilitating disease).
Antimicrobials are given, initially through a vein, then by mouth. Antibiotics which work against a number of different bacteria (broad spectrum antibiotics) are the most common antimicrobial prescribed. It is not uncommon for multiple antibiotic medications to be used in order to ensure effective treatment of the infection. Antifungal medications may also be prescribed if fungal infection is likely.
The presence of a compressive lesion (which is injuring brain tissue by pressing on it) or a large abscess with a high degree of swelling around it can raise intracranial pressure to the point where immediate treatment is needed.
Surgery is required if there is persistent or progressive increase in intracranial pressure, if the mass does not reduce after use of antimicrobial medications, or if the mass contains gas (produced by some types of bacteria). Surgery may also be needed if there are signs of impending rupture of the abscess into the fluid containing system of the brain (the ventricles).
Surgery consists of opening and draining the abscess and is usually accompanied by cultures of the fluid. This allows antimicrobial treatment to be adjusted so that it is specific to the causative microorganism. The specific surgical procedure depends on the size and depth of the mass. The entire mass may be removed (excised) if it is near the surface and completely encapsulated. Needle aspiration guided by CT scan or MRI scan may be needed for a deep abscess. This may also include injecting antimicrobials directly into the mass.
Osmotic diuretics and steroids may also be used to reduce swelling of the brain.
If untreated, the disorder is almost always fatal. The outcome is usually improved with the use of CT and MRI scans for accurate diagnosis and by the administration of broad-spectrum antimicrobials.
The death rate is around 10% with treatment. Neurologic changes may be chronic or may resolve over time. Seizures or neurologic losses (inability to move, speak, see) may occur after surgery.