WordNet

kill by smashing someones skull
mental ability; "hes got plenty of brains but no common sense" (同)brainpower, learning_ability, mental capacity, mentality, wit
that part of the central nervous system that includes all the higher nervous centers; enclosed within the skull; continuous with the spinal cord (同)encephalon
the brain of certain animals used as meat
hit on the head
symptom consisting of a localized collection of pus surrounded by inflamed tissue
infected and filled with pus; "an abscessed tooth"

PrepTutorEJDIC

『脳』,脳髄 / 《しばしば複数形で》『頭脳』,『知力』 / 《話》秀才,知的指導者 / …‘の'頭を打ち砕く
膿瘍(のうよう)(うんだできもの)
=brassiere,　brassiere

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/09/23 23:21:15」(JST)

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Brain abscess (or cerebral abscess) is an abscess caused by inflammation and collection of infected material, coming from local (ear infection, dental abscess, infection of paranasal sinuses, infection of the mastoid air cells of the temporal bone, epidural abscess) or remote (lung, heart, kidney etc.) infectious sources, within the brain tissue. The infection may also be introduced through a skull fracture following a head trauma or surgical procedures. Brain abscess is usually associated with congenital heart disease in young children. It may occur at any age but is most frequent in the third decade of life.

Signs and symptoms

Fever, headache, and neurological problems, while classic, only occur in 20% of people.^[2]

The symptoms of brain abscess are caused by a combination of increased intracranial pressure due to a space-occupying lesion (headache, vomiting, confusion, coma), infection (fever, fatigue etc.) and focal neurologic brain tissue damage (hemiparesis, aphasia etc.). The most frequent presenting symptoms are headache, drowsiness, confusion, seizures, hemiparesis or speech difficulties together with fever with a rapidly progressive course. The symptoms and findings depend largely on the specific location of the abscess in the brain. An abscess in the cerebellum, for instance, may cause additional complaints as a result of brain stem compression and hydrocephalus. Neurological examination may reveal a stiff neck in occasional cases (erroneously suggesting meningitis). The famous triad of fever, headache and focal neurologic findings are highly suggestive of brain abscess.

Pathophysiology

Bacterial

Brain abscess after metastasis treatment.

Anaerobic and microaerophilic cocci and gram-negative and gram-positive anaerobic bacilli are the predominate bacterial isolates. Many brain abscesses are polymicrobical. The predominant organisms include: Staphylococcus aureus, aerobic and anaerobic streptococci (especially Streptococcus intermedius), Bacteroides, Prevotella, and Fusobacterium species, Enterobacteriaceae, Pseudomonas species, and other anaerobes.^[3] Less common organisms include: Haemophillus influenzae, Streptococcus pneumoniae and Neisseria meningitides.^[4]

Bacterial abscesses rarely (if ever) arise de novo within the brain, although establishing a cause can be difficult in many cases. There is almost always a primary lesion elsewhere in the body that must be sought assiduously, because failure to treat the primary lesion will result in relapse. In cases of trauma, for example in compound skull fractures where fragments of bone are pushed into the substance of the brain, the cause of the abscess is obvious. Similarly, bullets and other foreign bodies may become sources of infection if left in place. The location of the primary lesion may be suggested by the location of the abscess: infections of the middle ear result in lesions in the middle and posterior cranial fossae;^[5] congenital heart disease with right-to-left shunts often result in abscesses in the distribution of the middle cerebral artery;^[6]^[7] and infection of the frontal and ethmoid sinuses usually results in collection in the subdural sinuses.

Other organisms

Fungi and parasites may also cause the disease. Fungi and parasites are especially associated with immunocompromised patients. Other causes include: Nocardia asteroides, Mycobacterium, Fungi (e.g. Aspergillus, Candida, Cryptococcus, Mucorales, Coccidioides, Histoplasma capsulatum, Blastomyces dermatitidis, Bipolaris, Exophiala dermatitidis, Curvularia pallescens, Ochroconis gallopava, Ramichloridium mackenziei, Pseudallescheria boydii), Protozoa (e.g. Toxoplasma gondii, Entamoeba histolytica, Trypanosoma cruzi, Schistosoma, Paragonimus), and Helminths (e.g. Taenia solium). Organisms that are most frequently associated with brain abscess in patients with AIDS are poliovirus, Toxoplasma gondii, and Cryptococcus neoformans, though in infection with the latter organism, symptoms of meningitis generally predominate.

These organisms are associated with certain predisposing conditions:

Sinus and dental infections—Aerobic and anaerobic streptococci, anaerobic gram-negative bacilli (e.g. Prevotella, Porphyromonas, Bacteroides), Fusobacterium, S. aureus, and Enterobacteriaceae
Penetrating trauma—S. aureus, aerobic streptococci, Enterobacteriaceae, and Clostridium spp.
Pulmonary infections—Aerobic and anaerobic streptococci, anaerobic gram-negative bacilli (e.g. Prevotella, Porphyromonas, Bacteroides), Fusobacterium, Actinomyces, and Nocardia
Congenital heart disease—Aerobic and microaerophilic streptococci, and S. aureus
HIV infection—T. gondii, Mycobacterium, Nocardia, Cryptococcus, and Listeria monocytogenes
Transplantation—Aspergillus, Candida, Cryptococcus, Mucorales, Nocardia, and T. gondii
Neutropenia—Aerobic gram-negative bacilli, Aspergillus, Candida, and Mucorales

Diagnosis

MRI (T1 with contrast) showing the ring-enhancing lesion. From a rare case report of an abscess formed as a complication of the CSF shunt. Jamjoom et al., 2009.^[1]

The diagnosis is established by a computed tomography (CT) (with contrast) examination. At the initial phase of the inflammation (which is referred to as cerebritis), the immature lesion does not have a capsule and it may be difficult to distinguish it from other space-occupying lesions or infarcts of the brain. Within 4–5 days the inflammation and the concomitant dead brain tissue are surrounded with a capsule, which gives the lesion the famous ring-enhancing lesion appearance on CT examination with contrast (since intravenously applied contrast material can not pass through the capsule, it is collected around the lesion and looks as a ring surrounding the relatively dark lesion). Lumbar puncture procedure, which is performed in many infectious disorders of the central nervous system is contraindicated in this condition (as it is in all space-occupying lesions of the brain) because removing a certain portion of the cerebrospinal fluid may alter the concrete intracranial pressure balances and causes the brain tissue to move across structures within the skull (brain herniation).

Ring enhancement may also be observed in cerebral hemorrhages (bleeding) and some brain tumors. However, in the presence of the rapidly progressive course with fever, focal neurologic findings (hemiparesis, aphasia etc.) and signs of increased intracranial pressure, the most likely diagnosis should be the brain abscess.

Treatment

The treatment includes lowering the increased intracranial pressure and starting intravenous antibiotics (and meanwhile identifying the causative organism mainly by blood culture studies).

Hyperbaric Oxygen Therapy (HBO2 or HBOT) is indicated as a primary and adjunct treatment which provides four primary functions Firstly HBOT reduces intracranial pressure.^[8] Secondly high partial pressures of oxygen act as a bactericide and thus inhibits the anaerobic and functionally anaerobic flora common in brain abscess. Third, HBOT optimizes the immune function thus enhancing the host defense mechanisms and fourth HBOT has been found to be of benefit when brain abscess is concomitant with cranial osteomyleitis.

Secondary functions of HBOT include increased stem cell production and up-regulation of VEGF which aid in the healing and recovery process.^[9]

Surgical drainage of the abscess remains part of the standard management of bacterial brain abscesses. The location and treatment of the primary lesion also crucial, as is the removal of any foreign material (bone, dirt, bullets, and so forth).

There are few exceptions to this rule: Haemophilus influenzae meningitis is often associated with subdural effusions that are mistaken for subdural empyemas. These effusions resolve with antibiotics and require no surgical treatment. Tuberculosis can produce brain abscesses that look identical to conventional bacterial abscesses on CT imaging. Surgical drainage or aspiration is often necessary to identify Mycobacterium tuberculosis, but once the diagnosis is made no further surgical intervention is necessary.

Prognosis

Death occurs in about 10% and people do well about 70% of time.^[2] This is a large improvement from the 1960s due to improved ability to image the head, better neurosurgery and better antibiotics.^[2]

References

^ ^a ^b Jamjoom AA, Waliuddin AR, Jamjoom AB (2009). "Brain abscess formation as a CSF shunt complication: a case report". Cases J 2 (1): 110. doi:10.1186/1757-1626-2-110. PMC 2639569. PMID 19183497.
^ ^a ^b ^c Brouwer, MC; Coutinho, JM; van de Beek, D (Mar 4, 2014). "Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis.". Neurology 82 (9): 806–13. doi:10.1212/WNL.0000000000000172. PMID 24477107.
^ Brook I (September 2009). "Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management". Int. J. Pediatr. Otorhinolaryngol. 73 (9): 1183–6. doi:10.1016/j.ijporl.2009.01.020. PMID 19249108.
^ Brook I (July 1995). "Brain abscess in children: microbiology and management". J. Child Neurol. 10 (4): 283–8. doi:10.1177/088307389501000405. PMID 7594262.
^ Macewan W (1893). Pyogenic Infective Diseases of the Brain and Spinal Cord. Glasgow: James Maclehose and Sons.
^ Ingraham FD, Matson DD (1954). Neurosurgery of Infancy andChildhood. Springfield, Ill: Charles C Thomas. p. 377.
^ Raimondi AJ, Matsumoto S, Miller RA (1965). "Brain abscess in children with congenital heart disease". J Neurosurg 23 (6): 588–95. doi:10.3171/jns.1965.23.6.0588. PMID 5861142.
^ http://membership.uhms.org/?page=IA
^ http://ajpheart.physiology.org/content/ajpheart/290/4/H1378.full.pdf

External links

Brain abscess at eMedicine
MR Diagnosis MedPix Imaging Brain Abscess

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 細菌性脳膿瘍の治療および予後 treatment and prognosis of bacterial brain abscess
2. 脳膿瘍の病因、臨床症状、および診断 pathogenesis clinical manifestations and diagnosis of brain abscess
3. 新生児における細菌性髄膜炎：神経学的合併症 bacterial meningitis in the neonate neurologic complications
4. 感染症を繰り返す成人に対するアプローチ approach to the adult with recurrent infections
5. 小児における頭痛の緊急評価 emergent evaluation of headache in children

English Journal

Cross-reactivity of Nocardia spp. in the fungal (1-3)-β-d-glucan assay performed on cerebral spinal fluid.

Koncan R1, Favuzzi V2, Ligozzi M2, Sorrentino A3, Cornaglia G2, Cascio GL3.
Diagnostic microbiology and infectious disease.Diagn Microbiol Infect Dis.2015 Feb;81(2):94-5. doi: 10.1016/j.diagmicrobio.2014.11.002. Epub 2014 Nov 29.
Cerebral spinal fluid from a patient affected by a brain abscess caused by Nocardia abscessus gave a positive result for (1-3)-β-d-glucan (BG) assay, in absence of any fungal infection. This study aimed to assess whether Nocardia spp. show cross-reactivity with BG assay. All Nocardia spp. analyzed
PMID 25497418

Spontaneous nocardial brain abscess in a juvenile rhesus macaque (Macaca mulatta).

Ferrecchia CE1, Ducore RM, Colgin LM, Lewis AD.
Journal of medical primatology.J Med Primatol.2015 Feb;44(1):45-8. doi: 10.1111/jmp.12153. Epub 2014 Dec 3.
BACKGROUND: A juvenile rhesus macaque presented with blindness, ataxia, and head tilt.METHODS: Postmortem gross and microscopic examination, histochemical staining and bacterial culture were performed.RESULTS: Nocardia sp. was identified as the etiologic agent of a primary pneumonia with secondary c
PMID 25470211

Trichosporon asahii infection presenting as chronic meningo-ventriculitis and intra ventricular fungal ball: a case report and literature review.

Kumar A1, Udayakumaran S, Babu R, Rajamma BM, Prakash A, Panikar D, Karim S, Chowdhary A.
Mycoses.Mycoses.2015 Jan 15. doi: 10.1111/myc.12282. [Epub ahead of print]
Central nervous system trichosporonosis is a rare clinical entity and so far only six cases including three each of brain abscess and meningitis has been on record. We report a rare case of chronic meningo-ventriculitis and intraventricular fungal ball due to Trichosporon asahii in an 18-year-old im
PMID 25590228

Japanese Journal

症例報告脳塞栓症に感染性心内膜炎と脳膿瘍併発が疑われ,重篤な呼吸障害がある患者の口腔ケア中に死亡した一例

水草あゆみ,神野洋輔,藤井航
日本歯科衛生学会雑誌 8(2), 53-58, 2014-02
NAID 40019980055

感染性心内膜炎に合併した多発脳膿瘍と脊髄髄内膿瘍の1例

蒲澤千昌,木村友美,内山由美子,岩田誠,内山真一郎
東京女子医科大学雑誌 84(E1), E192-E196, 2014-01-31
感染性心内膜炎に脳膿瘍のみならず、脊髄髄内膿瘍をMRIで確認しえた31歳男性例を報告した.発熱後、亜急性に両腋窩痛、右足先から右臍上部のしびれ感、四肢の筋力低下が出現した.多形核球優位の髄液細胞増多を認め、MRIで脳実質内の多発病変と頸髄-上部胸髄レベルに腫脹を伴うリング状の造影効果を認め、多発脳膿瘍と脊髄髄内膿瘍と診断した.4歳で心臓弁置換術と入院前に抜歯の既往があり、心エコーで僧帽弁に付着する …
NAID 110009752577

歯周囲感染症から発症した頭蓋内膿瘍の1例

本間博臣,竹村栄毅,油井健史,小野智裕,渡邉彩,林武史
Nippon Jibiinkoka Gakkai Kaiho 117(3), 206-208, 2014
頭蓋内感染症の半数が副鼻腔炎や中耳炎から発生するとされている. 歯性感染症からの発生頻度は2%とされており, 原因としてはまれである. 本例は歯周囲感染症から頬部→翼突下顎隙→翼口蓋窩→側頭下窩へと進展し, 化膿性顎関節炎を発症し卵円孔, 棘孔を介し頭蓋内膿瘍を発症した. 脳神経外科と合同で全身麻酔下に側頭下窩のデブリドマン・開頭穿刺吸引術を同一の皮膚切開にて行った. 側頭下窩への到達方法として, …
NAID 130003395310

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