Brain abscess and empyema

Which of the following heart conditions predispose to brain infection and abscess

A. Patent foramen ovale (PFO)
B. Coarctation of the aorta
C. Takayusu disease
D. Abdominal aortic aneurysm

All are true regarding brain abscess except

A. Infection from paranasal sinuses usually spread to frontal lobe

B. Hematogenous-borne brain abscess are usually multifocal

C. Primary intraventricular abscess is rapid progressive and causes pancerebritis

D. Microglia cells are considered to be CNS-resident professional macrophages against brain infection

Thick capsule in brain abscess amenable to excision is formed after

A. 4days
B. 10days
C. 40 days
D. 4 weeks

Most common organism causing brain abscess in immunocompromised individuals with T cell dysfunction is

A. Viridans streptococci
B. Propionibacterium
C. Bacteroides
D. Toxoplasma gondii

Management of brain abscess includes all except

A. Lumbar puncture (LP) is never recommended
B. Medical treatment recommended for a small abscess (<2.5 cm)
C. IV cefotaxime + metronidazole are most effective in Nocardia
D. Aminoglycosides are most effective in renal transplant recipients

All are true regarding Subdural empyema except

A. Associated with frontal skull osteomyelitis
B. The most common organisms encountered in Pott puffy tumor include anaerobic oral bacteria
C. High mortality is due to thrombosis in the cortical veins
D. The indications for craniotomy are multiloculated abscess and thick pus

In short

Pott puffy tumor

A “doughy” erythematous forehead swelling associated with fever is considered pathognomonic of Pott puffy tumor. Brain MRI with contrast is the study of choice if possible and available.

Metronidazole readily penetrates brain abscess, intralesional concentrations have been found to be 40 mg/ml; it has excellent bactericidal activity against many anaerobes.

In brain abscess, corticosteroids are recommended perioperatively for reducing intracranial pressure and avoiding acute brain herniation.

Anticonvulsant therapy for 5 years to all patients with BA may be recommended, discontinuation of antiepileptic drugs may be considered when a patient is seizure free for at least 2 years after surgery and electroencephalogram (EEG) shows no epileptic activity.

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