Brain Abscess: Causes, Symptoms and Treatment [Full]

What is a Brain Abscess?

A brain abscess is a condition when infection or injury to the brain causes a collection of pus to form in brain tissue ^{[1,2,3,5,6,7]}.

Although people who have low immunity are more prone to brain abscesses, this disease is very rare.

If a person has a brain abscess and is not treated immediately, a brain abscess will threaten the life of the sufferer.

Overview
Brain abscess is a buildup of pus in brain tissue due to infection or injury to the brain which if not treated quickly will be fatal.

Facts About Brain Abscess

1. In the United States, recorded cases of brain abscess per year can reach 1,500-2,000 cases ^[2].
2. Brain abscess can occur in children and adults where the risk is higher in infants and children aged 4-7 years and male adults under 30 years of age. ^[2].
3. Brain abscess was a type of disease that was fatal and deadly in the past, but according to researchers in 2014 the treatment of brain abscess has developed rapidly, increasing the chances of survival of the sufferer. ^[3].
4. Before the existence of antibiotic drugs, the death rate of brain abscesses was classified as very high where there were 5-6 brain abscess sufferers in Indonesia who died
5. In 1950-1960 there was a mortality rate of 6% of 35 patients with otogenic brain abscess, and from 18 cases in 1861-1971, the mortality rate had fallen to 0%.
6. A brain abscess is known to be more common in developing countries.

Causes of Brain Abscess

Fungi or bacteria that infect brain tissue are the most common causes of brain abscess conditions.

Bacteria of the Enterobacter, Staphylococcus, Streptococcus, Bacteriodes, or Streptococcus groups are the most frequent causes of pus accumulating in the brain ^[1,2,3,6].

As for fungi, the Toxoplasma gondii and Aspergillus groups are the most common causes of abscess formation in the brain.

Inflammation and swelling can occur in parts of the brain that have been infected by parasites, bacteria or fungi.

In this condition, it means that the abscess includes active and dead white blood cells and infected brain cells.

When the abscess gets bigger, the abscess will put pressure on the area around the brain tissue, which then has an impact on the blockage of blood vessels.

When blood vessels are blocked, blood flow is not smooth, which means that the supply of oxygen and nutrients that should reach the brain is blocked.

If you don’t get treatment right away, brain tissue doesn’t get enough oxygen and nutrients, which can lead to serious damage to this vital organ.

Although the main cause is a bacterial or fungal infection, there are a number of factors that can increase a person’s potential to develop a brain abscess more easily, including: ^{[1,2,3,5,6,7]} :

• Have congenital heart disease
• Having a skin infection
• Having a pelvic infection
• Have endocarditis or infection of the inner lining of the heart (endocardium)
• Have a lung infection
• Having an infection in the abdominal cavity
• Having an ear infection
• Experience tooth abscess
• Experience sinusitis
• Experience pneumonia or an infection that causes the air sacs in the lungs to become inflamed
• Have pulmonary vascular disorders

Overview. 
Bacterial, fungal or parasitic infections can be the main cause of the onset of brain abscesses. But various other medical conditions as well as injuries to the head can increase the risk of brain abscesses.

Symptoms of Brain Abscess

The initial and main symptom of a brain abscess is body spasm where this is accompanied by several other symptoms, such as: ^[1,2,3,6,7]:

• Headache
• Fever
• Nausea followed by vomiting
• Blurred vision
• Double vision
• The shoulders, neck, and shoulders feel stiff and tense
• Dazed or feeling confused
• Concentrated power decreased
• The thought process slows down
• Poor response rate
• Lethargic and easy to fall asleep
• Easily offended and angry
• Coma

Meanwhile, in about 50-65% of cases of brain abscess, the following neurological symptoms often accompany headaches:

• Poor body coordination
• Impaired speech or speech becomes unclear
• Weakness on one side of the body which sometimes also occurs in the form of paralysis
• Muscle weakness

Nausea accompanied by vomiting is usually caused by pressure in the brain that continues to grow.

Meanwhile, the pain that is felt, generally occurs on the side of the head where the brain abscess occurs and this can be experienced suddenly or slowly.

Abscesses can continue to grow and become wider where this occurs as a result of infection, pressure on the brain and also damaged brain tissue at the same time.

When the abscess has ruptured, then as the main sign, the patient will experience a very severe headache.

If the headache worsens suddenly, then immediately consult a doctor.

When should you see a doctor?

If the muscles experience weakness, convulsions begin to be experienced frequently without a history of seizures or epilepsy, and / or speech disorders occur, as soon as possible, the patient needs to see a doctor .

High fever is also a symptom that should not be underestimated, so go to the doctor immediately to get the most appropriate treatment.

Overview
The initial and main symptoms of brain abscesses are seizures that are also accompanied by fever, headache, nausea and vomiting. When a severe headache strikes, this indicates that the abscess has ruptured.

Brain Abscess Examination

To confirm the condition of the symptoms experienced by the patient is really a brain abscess and to determine the cause of the brain abscess, a series of examination methods are carried out by the doctor. ^{[1,2,3,5,6,7]}.

• Physical Examination: The doctor will first examine the patient’s physical, such as body temperature and other physical symptoms.
• Medical History Examination: The doctor needs to know the patient’s medical history and will ask the patient some questions about whether the patient has had a recent infection, whether the patient’s immunity is low. The doctor will also ask about the patient’s travel history in evaluating symptoms.
• Blood Test: This test is done so that the doctor can determine the level of the patient’s white blood cells, which is also an indicator of the presence and extent of the spread of infection in the body.
• Scanning Tests: Scanning tests include CT or MRI scan needed by the doctor to find out where the brain abscess is located.
• Blood Culture: Different from a blood test, a blood culture is an examination method that will help the doctor in finding out the presence of fungi, parasites or bacteria that are causing abscesses in the patient’s body.
• Biopsy: A sampling of tissue to be examined in this laboratory to identify any cells or brain tissue that has changed. Usually a biopsy can also be done to determine the type of pathogen causing the abscess.
• Lumbar Puncture: The doctor performs this examination to determine the type of bacteria that has caused the infection and resulted in a brain abscess.
• EEG or Electroencephalogram : The doctor will also check the electrical activity of the patient’s brain associated with symptoms such as seizures that occur repeatedly.

Overview.
Various examination methods may need to be taken by the patient, ranging from physical examination, medical history, blood tests, blood cultures, EEG, lumbar puncture, biopsy, and scanning tests.

Brain Abscess Treatment

Brain abscesses are generally treated through two methods, namely drug therapy and surgical routes depending on how severe the condition of the abscess in the patient’s brain is.

The treatment given by a doctor is usually based on the patient’s overall health condition, the cause of the abscess, how many abscesses arise, and the size of the abscess.

1. Drugs

If the brain abscess is caused by fungi or bacteria, then the doctor will give antifungal drugs or antibiotics ^[1,2,5,6,7].

These two types of drugs are also often used to treat brain abscesses where toxoplasmosis is the cause..

Meanwhile, anti-seizure drugs are given to patients to reduce the intensity and frequency of seizures.

Steroids or diuretics may be prescribed by doctors to patients to relieve swelling in the brain.

Both of these drugs are known to be effective in reducing intracranial pressure that occurs in the brain.

2. Surgery

Surgery is an option to remove the abscess from the patient’s brain tissue ^{[1,2,3,5,6,7]}.

Usually this action is recommended by doctors if the abscess is large enough, which is more than 2 cm.

In addition, surgery will be recommended if the risk of abscess rupture is very high, so it is feared that it will cause damage to the surrounding brain tissue.

• Craniotomy: This surgical procedure is performed by a doctor by removing a small portion of the skull bone to remove an abscess that is located in the brain tissue. Removing a small part of the skull will make it easier for doctors to reach brain tissue that has been infected and then the doctor will proceed with removing the abscess.
• Simple Aspiration: This type of surgery simple aspiration is a method used by doctors to remove pus buildup. This procedure is usually performed by utilizing a CT scan. CT scans are useful as a helper for doctors in ascertaining the location of the abscess.

Even if the brain abscess patient has received treatment, it is possible that the doctor may ask the patient to remain in the hospital for hospitalization for several weeks.

It is necessary to wait until the patient is completely recovered and the effects of the abscess are gone.

The patient also still has to undergo a CT scan so that the doctor can confirm that the brain abscess has completely disappeared.

After a hospitalization, patients still have to really rest for approximately 6-12 weeks at home before returning to their normal activities.

Not only that, patients need to avoid strenuous activities for a while.

Sports that have a high risk of injury or physical contact must be avoided after receiving brain abscess treatment.

Overview.
The administration of antibiotics, antifungals, and anti-cramps is the main treatment for people with brain abscesses. However, if the abscess is larger than 2 cm in size, the doctor will recommend surgical removal of the abscess.

Complications of Brain Abscess

Several complicated conditions can occur, either the abscess is not treated or has been treated, including: ^[1,2,3,5]:

• Abscess relapse
• Meningitis, namely inflammation of the lining of the brain; This condition can occur as a complication in patients with brain abscesses who are still children and can threaten the health of the sufferer.
• Epilepsy, is a condition that can develop because a brain abscess causes repeated seizures in the sufferer. Epilepsy is a long-term condition that can only be controlled with medication.
• Brain damage. This complication can occur characterized by difficulty speaking to the loss of the ability to speak altogether. Brain damage can occur permanently if a brain abscess is treated too late.

Brain Abscess Prevention

Avoiding the cause is the most recommended way to prevent brain abscess and the following steps can be taken: ^[7]:

• Wear head protection when working in an environment where there is a high risk of injury.
• Wear a helmet when driving.
• Maintain healthy oral hygiene and health (including teeth and gums).
• Check your dental health regularly to the dentist.
• Avoid excessive and indiscriminate use of drugs.
• Eat nutritious food.
• Do not smoke.
• Do regular exercise.
• Treat immediately medical conditions that have the potential to trigger a brain abscess.
• Get checked as soon as possible if you have an infection.

Overview.
In order not to have a brain abscess, a person needs to take care of his body not to develop an infection. Through a healthy lifestyle, treating certain medical conditions as soon as possible, and wearing head protection when working on an injury-prone environment or while driving.