The Client with a Brain Abscess

A brain abscess is an infection with a collection of purulent matenal within the brain tissue. Approximately 75% of brain abscesses are found in the cerebrum; 25% are found in the cerebellum. Approximately 40% of all brain abscesses extend into the brain by traveling from middle ear and mastoid infections along the wall of the cerebral veins. Sinus infections, direct trauma to the brain, and neurosurgery allow immediate access and are responsible for approximately 10%. The remaining 50% are the result of infections in other sites within the body that cause septic emboli to travel via the bloodstream to the brain. Common sources of septic emboli include the lungs (lung abscess), the heart (bacterial endocarditis), the pelvis (pelvic abscesses), skin infections, and complications associated with some forrrts of meningitis.


A brain abscess results from the presence of microorganisms in the brain tissue. Occasionally the abscess does not become encapsulated; instead, it spreads through the brain tissue to the subarachnoid space and ventricular system. If the abscess is encapsulated, it has the ability to enlarge and, therefore, behave as a space-occupying lesion within the cranium. This predisposes the client not only to the systemic effects of the inflammatory process but also to the serious consequences of increased intracranial pressure.
Initialy, The clien exhibits The general symptoms associated with an acute infectious process, such as chills, fever, malaise, and anorexia. Because brain abscess generally forms after infection, the client may consider these signs to be an exacerbation of that illness. As the abscess enlarges. neurologic signs may increase.

Collaborative Care

Treatment of the client with a brain abscess focuses on the prompt initiation of the antibiotic therapy. Other manifestations are treated symptomatically-as with the client diagnosed with meningitis or encephalitis. If pharmacologic management is not effective, the abscess ma)’ be drained or, if it is encapsulated, removed.

Laboratory and Diagnostic Tests

Diagnosis of a brain abscess can present some difficulties because of the lack of definitive symptoms and a some-what confusing clinical picture. The following diagnostic tests may be helpful in identifying a primary cause:

• X-ray films of the chest, skull, and sinuses may help identify a primary source of infection.
• Lumbar puncture reveals a markedly elevated pressure (200 to 300 mm water), with elevated protein content and elevated white blood cell count. Glucose
content is normal, and culture and sensitivity are negative because the bacteria are encapsulated.

Antimicrobial therapy is the primary treatment for brain abscess. Anticonvulsant medications may be given as prophylaxis against seizures.

Surgical drainage of an encapsulated abscess is considered somewhat controversial. The decision to perform surgery is based on the client’s general condition, the stage of abscess development, and the site of the adscess.

Nursing Care
A careful history and nursing assessment is important to assist in identifying brain abscess. Nursing diagnoses and interventions are generally the same as those previously discussed for clients with meningitis and increased intracranial pressure.

Priscilla LeMone, Karen M. Burke. 1996. Medical-Surgical Nursing : Critical
Thinking in Client Care. California, Addison-Wesley Nursing.

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