Title: Brain Abscess Resulting from Aural and Sinus Infections
Abstract: ABSCESSES of the brain, arising from infection of the paranasal sinuses or mastoid infection, are usually single, first passing through a stage of septic encephalitis, followed by encapsulation. If the infection of the brain is caused by highly virulent organisms, a rapid necrosis of the brain tissues may follow, and encapsulation does not take place. Treatment of an abscess of this type nearly always fails. It is the purpose of this paper to discuss some of the important features of brain abscess and to describe a method of treatment which, in the author's hands, has given fairly satisfactory results. It is probable that the technic of operation for brain abscess will be further refined, and that reduction of the present mortality rate will be accomplished by applying different methods of operative treatment to different types of abscess. The size of the abscess, its subcortical depth, and the density of the capsule must all be taken into consideration in deciding whether or not drainage should be employed, and, if used, the selection of the point in the abscess wall into which the drainage material is to be placed. Multiple, metastastic abscesses are not considered, as they are rarely amenable to surgical treatment. Brain abscesses arising from infection of the frontal sinuses usually develop in the adjacent frontal lobe. Those arising from aural infections are found either in the adjacent temporal lobe or the cerebellar hemisphere of the corresponding side. McEwen found cerebellar abscesses more frequently than those of the cerebral hemispheres. In a series of 31 cases of encapsulated brain abscess, we have recorded only three cases in which the abscess was located in the cerebellum. While abscesses may result from penetrating wounds of the brain, or even from untreated scalp lacerations without fracture of the skull, it is rare for abscess of the brain to follow a primary acute infection either of the frontal sinuses or of the mastoid. It evidently requires a considerable period for infection to break down the barriers which exist between the inflammation of the bony cavities and the brain. It is generally believed that a transfer of infection from the sinuses, or mastoid, to the brain takes place through the blood vessels which enter the brain adjacent to the infected bone. Infected thrombi form in these vessels, and, by retrograde propagation, the infection enters the white substance, in which the blood supply is poor and the level of resistance to infection is low. In this stage, the inflammation of the brain in the region of the infected vein is diffuse, but tending to become encapsulated, provided the virulence of the organism is not overwhelming. It is thought that about three weeks are required for the abscess to become encapsulated. During the early stage of abscess formation, that is, during the stage of septic encephalitis, high temperature, chilly feeling, and evidence of systemic sepsis are present.
Publication Year: 1933
Publication Date: 1933-07-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 2
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