Brain Abscess

Introduction:

Collection of pus creates a space-occupying area within the brain. Symptoms are
similar to any other space-occupying lesion. The infection may be a primary site
within the brain or may have traveled from nearby sites such as the ear or sinuses
through bone erosion. It may also enter the brain via the systemic circulation from
any infected site in the body, such as the lungs in bronchiectasis. The organism
causes a local inflammatory reaction; there is pus and liquification of the affected
tissue. Cerebral edema of the surrounding tissue occurs. The area becomes en-capsulated within 10 to 14 days from the onset of the infection. The infections are
typically streptococci, staphylococci, anaerobes, or mixed-organism infections.
Immunocompromised patients may have fungal or yeast present in the abscess. Up
to 20 percent of the patients may have more than one abscess.

PROGNOSIS

Identification of the organism and appropriate treatment is imperative to resolution
of the infection. There is a significant mortality rate in these patients.

SIGNS AND SYMPTOMS

• Drowsiness due to increased intracranial pressure
• Headache due to increased intracranial pressure
• Confusion or inattention
• Seizures due to irritation of brain tissue
• Increasing intracranial pressure
• Widened pulse pressure and bradycardia due to increased intracranial pressure
• Focal neurologic deficit, depending on location of abscess
• Nystagmus with cerebral abscess
• Aphasia with frontal lobe abscess
• Loss of coordination (ataxia) with a cerebellar abscess

TREATMENT

• Surgically drain (aspiration or open) the abscess to relieve intracranial
pressure.
• Administer antibiotic intravenously, depending on organism:
• nafcillin sodium (penicillinase-resistant penicillin)
• penicillin G benzathine
• chloramphenicol
• metronidazole
• vancomycin
• Administer corticosteroids in divided doses to decrease inflammation:
• dexamethasone—taper dose down before stopping
• Administer anticonvulsants to reduce seizure risk; watch for drug interactions:
• phenytoin
• phenobarbital
• Administer osmotic diuretics to decrease cerebral edema:
• mannitol

NURSING DIAGNOSES

• Risk for disturbed thought process
• Risk for falls

NURSING INTERVENTION

• Assess the patient’s ability to think, reason, and remember.
• Assess the patient’s speech capabilities.
• Assess the patient’s movement and senses.
• Assess the patient’s cranial nerve function.
• Monitor vital signs.
• Monitor fluid intake and output.
• Monitor for signs of infection in post-operative patients.
• Monitor for side effects of medications.
• Explain to the patient:
• Need for continued antibiotic treatments.
• How to administer IV antibiotics at home, how to monitor IV access, and
when to call for problems.
• Need for follow up CT scan or MRI imaging for monitoring.