abses otak.ppt

8/10/2019 abses otak.ppt

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Abses otak

Fakultas Kedokteran Atma Jaya 2008

Oleh : Caroline M.(2003 61 182)Christina Chandra (2007 61 066)Magdalena Niken. (2007 61 145)

Pembimbing : dr. George Dewanto , Sp. S


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Penimbunan nanah yang terlokalisasi

Selubung yang disebut kapsel.

Tunggal atau multiple

Abses otak

https://reader010.{domain}/reader010/html5/0606/5b17dfc953d96/5b17d


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Predisposing Conditions & MicrobiologyPredisp os ing Condi t io n Usual Microbia l Iso lates

Otitis mediamastoiditis

StreptococciBacteroides and PrevotellaEnterobacteriaceae

Sinusitis Streptococci, Bacteroides

Enterobacteriaceae,S. aureus,Haemophilus

Dental sepsis Mixed Fusobacterium, Prevotella

Bacteroides streptococciTrauma S. streptococci,

or postneurosurgicalaureus, Enterobacteriaceae, Clostridium


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Lung abscess empyema Fusobacterium, Actinomyces,Bacteroides and Prevotella

bronchiectasis streptococci, NocardiaBacterial endocarditis S. aureus,streptococci

Congenital heart disease Streptococci, HaemophilusNeutropenia gram-negative bacilli,

Aspergillus , Mucorales, CandidaTransplant Aspergillus ,Candida ,Mucorales,

Enterobacteriaceae, Nocardia T.gondii

HIV T. gondii, NocardiaMycobacteriumListeria monocytogenes,Cryptococcus neoformans


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Bacterial

Fungal (aspergillus, candida, dll)

Protozoal and Helminthic


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Streptococci most commonly (70%)

Bacterial Brain Abscess

Mixed infections (30% to 60%) S t rep toc occu s m i l ler i group Oral cavity, appendix, and female genital tract Otopharyngeal infections , After neurosurgical or other medical procedures

S taph y loco cc us aureus for 10% to 15% cranial trauma


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mixed infection

Bacteroides and Prevotella in 20% to 40%

Enteric gram-negative bacilli (e.g., Proteusspecies, Escherichia coli, Klebsiella andPseudomonas ) in 23% to 33%

otitic infection Septicemia neurosurgical procedures immunocompromised


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rarely


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Mycobacterium tuberculosis

Nontuberculous mycobacteria


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Fungal Brain Abscess

Candida most etiology

corticosteroid, broad-spectrum antibiotic

hyperalimentation

malignancy

neutropenia,

chronic granulomatous disease, DM

thermal injuries


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rarely isolated brain infection Lungs paranasal sinuses

neutropenic in hematologic malignancy hepatic disease Cushings syndrome DM, CGD, HIV ,injection drug abusers postcraniotomy organ transplant corticosteroid

Aspergillus


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Protozoal and Helminthic Brain Abscess

Toxoplasma gondii

is the most common Immunocompromised hosts

Taenia solium

Trypanosoma cruzi Entamoeba histolytica

Schistosoma

Paragonimus

Neurocysticercosis


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most common middle ear, mastoid cells, or paranasal sinuses. otitis media : temporal lobe , cerebellum Paranasal sinusitis : frontal lobe

sphenoid sinusitis: temporal lobe , sella turcica molar teeth : frontal lobe

Pathogenesis

Contiguous focus of infection

. usually multiple, higher mortality chronic pyogenic lung diseases lung abscess, bronchiectasis, empyema, and cystic wound and skin, osteomyelitis, pelvic infection

Hematogenous from a distant focus of infection


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Patent foramen ovale

Trauma

Cryptogenic

open cranial fracture with dural breach neurosurgery or foreign body


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early cerebritis (days 1 to 3) late cerebritis (days 4 to 9) early capsule formation (days 10 to 13) late capsule formation (day 14 and later

Four stages of brain abscess evolution


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Acute inflammatoryinfiltrate with visiblebacteria on Gramstain and marked

edema surroundingthe lesion.

No contrastenhancement

Early cerebritis stage


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The center of the lesionbecomes necrotic,

Macrophages andfibroblasts invade theperiphery

Proliferate blood vessel

surrounding lesion

Late cerebritis stage


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necrotic center decrease in size

development of a collagenous capsule that is less prominent on the ventricular side of the lesion

cerebral edema starts to regress during this stage.

Early capsule formation


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The collagen capsule was complete

Circumferentially

Increased in density and thickness

The wall of abscess consists

Late capsule formation


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Symp tom or S ign Frequency (%)

Headache 70

Mental State Changes 70

Focal Neurologic Deficits >60

Fever 45 50Triad of Headache, feverand neurologic deficits


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Brain abscess

Primary or metastasis brain tumor

Subacute ischaemic infarction Resorbing haematoma

Demyelinating disease

Differential diagnosis of ring enhancingcerebral lesions


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Diagnosis

Abses Otak


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hypodense center surrounded by smooth,

regular thin-walled capsules with areas of ring

enhancement.

surrounded by variable hypodense area of brain edema

nodular enhancement

areas of low attenuation without enhancement,

during the early cerebritis

CT Scan Otak


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Differentiation between pseudo-capsule and truecapsule may be achieved by delayed scanningafter IV contrast medium, in cerebritis stage thecentre of the lesion will fill in with contrast

medium, whereas with mature abscess, there isnever enhancement of the pus-filled centre.

thick or markedly irregular wall suggests atumor rather than an infective lesion


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a ring or doughnut representing spherical wall or

capsule of abscess contrast enhancement being result ofbreakdown of

blood brain barrier and hypervascularity of the granulation tissue nonenhancing abscess centre is pus or nonviable

debris commonly extensive edema of vasogenic type in

surrounding white matter.

CT Scan Otak


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capsule is usually less well developed onventricular side than on cortical side.

useful for following the course of brain abscess

although after aspiration, improvement in the CTappearance may not be seen for up to 5 weeks orlonger.

CT Scan Otak


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first imaging choice

more sensitive than CT

variable & change with the stage of abscess

therapy with corticosteroids can decrease

enhancement seen with both CT and MRI

M R I


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Figure 2 MRI of the brain showing themidline shift to the left (red arrow), with a mass

effect at the midbrain and the ventricular level.

Figure 1 MRI of the brain showing lesions inthe lateral ventricle (red arrow), right parietal(yellow arrow), and right occipital lobe (bluearrow).


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Cerebral Tub ercu lom a

Figure 3


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Cerebellar abscess and mastoiditis (contrast CT)
http://www.aic.cuhk.edu.hk/web8/Hi%20res/Cerebellar%20abscess%20&%20mastoiditis.jpg


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(Atas) Lihat proptosiskanan disebabkan olehekstensif varises orbitamedia dan pembesaranencephalocoele

intranasal para-median.(Bawah) Perbaikansebagian dari proptosismengikuti pengobatansukses denganantibiotik.


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CT scan menunjukkan varices orbita dan encephalocoele nasal. (b) CT Scan menunjukkanencephalocoele menyebabkan obstruksi drainase maksila-antral. (c) CT scan menunjukkanabses otak pada lobus frontal kanan. (d) Scan MRI koronal melalui orbita menunjukkanencephalocoele dan formasi abses/serebritis ekstensif. (e) MRI sagital dari tulang belakangmenunjukkan empyema subdural intraspinal (anak panah)

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abses otak.ppt