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    Intracranial infectionIntracranial infection Meningitis Brain abscess

    Dural space infection

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    Meningitis

    Clinical manifestation

    (Petechial rash) Meningococcus Investigation

    Lumbar puncture ( CT brain before LP)

    CSF smears/stains CSF antigen screens CSF profile

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    Meningitis

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    Complication

    Brain abscess Subdural and epidural empyema Hydrocephalus Seizure

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    Treatment

    Medical

    Antibiotic

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    Treatment

    Medical

    Corticosteroid

    Surgery CSF leak from fistula

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    Brain abscess

    Epidemiology

    40,

    : 1.5 -3:1 85%

    Supratentorium Frontal lobe

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    Pathogenesis

    Hematogenous spreadingHeartLung

    Most common site : Middle cerebralartery Contiguous spreading (Most

    common)(Osteomyelitis) Diploic,Emissary(Thrombosis)

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    Pathogenesis

    Direct penetrating trauma

    csf

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    Risk factor

    Cyanotic congenital heart : Rightto left shunt

    (Reoperation) 4 .

    ,

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    4

    Early Cerebritis (D1-3) Focal area ofinflammation,Microvascular congestionwith PMN infiltration of the perivascular

    space

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    Late Cerebritis D4-10 :Central

    area of Necrosis Early Capsule formation 11-13 (Fibrotic capsule)

    Gliosis,

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    Late Capsule formation

    14 3 Gliotic Collagen Granulation

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    Microbiology

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    Clinicalmanifestation

    (No pathognomonic sign) 1.) Increased intracranial pressure : 2.) Alteration of conscious (70-95%)

    3.) Fever 40-50%4.) Focal neurological deficit 50-80%5.) Symptoms of infection : Sinusitis

    6.) Seizure 30-50%7.) Meningeal irritation 20%

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    Investigation

    MRI T1

    Hypointensity T2 Hi signal

    T1 Hypointensity

    , Hypersignal

    T2 Hyperintensity

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    Brain MRI:T2 weighted axial image shows a

    hyperintense lesion in the right posterior temporalregion with edema (arrows)

    Corresponding postcontrast T1 weighted axial imagedemonstrates rim enhancement of the lesion (red arrow).

    Also note the mild posterior enhancement in the leftglobe representing the enhancing retina (yellow arrow)

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    CT

    (Hypodensity lesion)

    Ring enhancement lesion Ringenhancement lesion

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    Treatment

    Medical Antibiotics Steroid Anti-epileptic

    Surgical Stereotactic aspiration

    Craniotomy Resection Eradicating source of infection

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    Treatment

    Medical treatment

    Antibiotics : indication1.)

    2.) 3.) 2.5 . 4.) 5.) 2

    Steroid : Brain herniation

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    Surgical treatment

    Stereotactic aspiration :

    Craniotomy Resection

    Mass effect : surface Retain Foreign body Fungal infection CSF fistula

    Brain edema Decompressive Craniectomy Internal decompression

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    Complication, Prognosis

    Complication Brain herniation, Ventriculitis,

    meningitis

    Prognosis-Mortality cause: Brain herniation -Factor : Mental status, Brain

    herniation, Coma

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    Dural space infection

    (Epidural abscess and Subdural empyema)

    32 10000

    >

    3:1

    70-80% Convexity 20%Parafalcine

    Subduralempyema Epiduralempyema

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    Subdural Empyema

    bacteria and fungus canspread to subdural spacep

    subdural empyemaarachnoid and subarachnoidspaces usually unaffected

    thrombophlebitis maydevelop in bridging veins pvenous occlusion and infarct

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    Clinicalmanifestation

    Epiduralabscess Subdural empyema

    (Meningismus)

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    Investigation

    Bone

    Epidural

    Subdural

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    Epidural empyema

    Epidural empyema

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    Treatment

    (Burr hole) Craniotomy Subdural empyema

    Craniectomy Epidural abscessprevent osteomyelitis

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    Complication

    20-25%(Cerebritis)(Cortical venous

    thrombosis)(Cerebral infarction)


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