Brain Abscess

INTRODUCTION 

A brain abscess can occur as a result of the focus perkontinuitatum spread infection around the brain and haematogenously from distant places, or directly such as head trauma and craniotomy operations. Abscesses that occur by haematogenous spread can be on any part of the brain, but most often in meetings substantia alba and grisea; while perkontinuitatum usually located in regions near the surface of the lobes of the brain in particular. brain abscess is solitary or multiple. That multiple is usually found in cyanotic congenital heart disease; the right to left shunt will cause systemic blood is not saturated, so always occur secondary polycythemia. This facilitates the occurrence of polycythemia trombo-emboli.3 

Two-thirds of brain abscesses are solitary, only one third are multiple brain abscesses. In the early stages of brain abscess diffuse inflammatory reaction in brain tissue with infiltration of leukocytes with edema, congestion perlunakan and brain tissue, sometimes accompanied by bleeding spots. After a few days to several weeks and liquefaction necrosis in the center of the lesion so as to form an abscess cavity. Astroglia, fibroblasts and macrophages surrounding the necrotic tissue. At first the abscess is not demarcated but over time with progressive fibrosis of the capsule formed by the concentric walls. Capsule thickness between a few millimeters to several centimeters. Some experts divide the pathological changes of brain abscess in four stages, namely: 3 

Early Stage serebritis 

Serebritis advanced stage 

Early stages of capsule formation 

Capsule formation stage lanjut.3 

Substantia alba abscess in the capsule can be further enlarged and extended toward the ventricles so that in case of rupture, can cause meningitis. Facial tissue infection, orbital cellulitis, sinusitis etmoidalis, amputation meningoensefalokel nasal and apical dental abscess can cause brain abscess located in the frontal lobe. Otitis media, mastoiditis especially cause brain abscess and cerebellar temporal lobe, parietal lobe abscess is usually the case in haematogenous. 4 

CLINIC OVERVIEW 

In the early stages of brain abscess clinical picture is not typical, there are symptoms of infection such as fever, malaise, anorexia and the symptoms of intracranial pressure elevation symptoms of vomiting, headaches and seizures with symptoms of brain abscess the size of a typical form of brain abscess triad consisting of symptoms infection, elevation of intracranial pressure and neurologic symptoms fokal.4 

Abscess in the frontal lobes are usually quiet and when there are neurological symptoms such as hemikonvulsi, hemiparesis, hemianopsia homonym with a decreased awareness show unfavorable prognosis due to herniation and perforation usually occurs into the ventricular cavity. Temporal lobe abscess in addition to causing hearing loss and disfasi acquired taste, vision defects and contralateral quadrants pedestal ianopsikomplit hem. Motor disturbances, especially the face and upper limbs may occur if the expansion of the abscess into the frontal lobe is relatively asymptomatic, located primarily in the anterior region, so that the focal symptoms are symptoms sensorimotorik. Cerebellar abscesses are usually located on one hemisphere and cause coordination problems such as ataxia, tremor, and nystagmus dismetri. Brain stem abscesses are rare, usually from haematogenous and result in danger

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