- A brain abscess is a collection of infectious material within the tissue of the brain.
- Bacteria are the most common causative organisms. An abscess can result from intra-cranial surgery, penetrating head injury, or tongue piercing.
- Organisms causing brain abscess may reach the brain by hematologic spread from the lungs, gums, tongue, or heart, or from a wound or intra-abdominal infection. It can be a complication in patients whose immune systems have been suppressed through therapy or disease.
- To prevent brain abscess, otitis media, mastoiditis, rhinosinusitis, dental infections, and systemic infections should be treated promptly.
- Generally, symptoms result from alterations in intracranial dynamics (edema, brain shift), infection, or the location of the abscess.
- Headache, usually worse in morning, is the most prevailing symptom.
- Fever, vomiting, and focal neurologic deﬁcits (weakness and decreasing vision) occur as well.
- As the abscess expands, symptoms of increased intracranial pressure (ICP) such as decreasing level of consciousness and seizures are observed.
Assessment and Diagnostic Methods
- History of of infection(s).
- Neuroimaging studies such as MRI or CT scanning to identify the size and location of the abscess
- Aspiration of the abscess, guided by CT or MRI, to culture and identify the infectious organism
- Blood cultures, chest X-ray, electroencephalogram (EEG)
- The goal is to eliminate the abscess.
- Treatment modalities include antimicrobial therapy, surgical incision, or aspiration (CTguided stereotactic needle).
- Medications used include corticosteroids to reduce the inﬂammatory cerebral edema and antiseizure medications for prophylaxis against seizures (phenytoin, phenobarbital).
- Abscess resolution is monitored with CT scans.
Nursing Management & Interventions
- Nursing interventions should support the medical treatment, as do patient teaching activities that address neurosurgical procedures.
- Patients and families need to be advised of neurologic deﬁcits that may remain after treatment (hemiparesis, seizures, visual deﬁcits, and cranial nerve palsies).
- Frequently assess neurologic status, especially LOC, speech and sensorimotor and cranial nerve functions.
- WOF signs of increased ICP: decreased LOC, vomiting, abnormal pupil response and depressed respirations.
- The nurse assesses the family’s ability to express their distress at the patient’s condition, cope with the patient’s illness and deﬁcits, and obtain support.
- Always provide safety measures.