Post-neurosurgical Brain Abscess and Subdural Empyema

Synonyms

Cerebral abscess

Definition

Brain abscess is a focal intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. Patients usually present with focal neurological deficits and may or may not have a fever or peripheral signs of infection or symptoms due to increased intracranial pressure like headache or nausea and vomiting. Brain abscess can follow craniotomy, craniectomy, ventriculostomy, ventriculo-peritoneal shunt placement, Halo traction or intracranial monitor placement. The most common post-neurosurgical pathogens include Staphylococcus species, Enterobacteriaceae, and Streptococcus species.

Subdural empyema is located in the potential space between the dura and the arachnoid, spreads rapidly due to the lack of anatomical boundaries, and shows therefore less mass effect than brain abscess. Symptoms begin with fever, focal neurological deficit (mainly hemiparesis), nuchal rigidity,...