Examination with CTMRT | Brain abscess

Examination with CTMRT

A brain abscess can be easily distinguished from other diseases of the brain in CT (computed tomography) or MRT (magnetic resonance imaging). The imaging of the capsule is very impressive and can often be identified perfectly as a brain abscess. In the CT image, which is usually performed with a contrast medium, a ring-shaped structure appears which is much brighter than the surrounding brain tissue (hyperdens = high density of the structure).

The tissue in the capsule, the pus, is darker than the surrounding tissue due to its fluid form (hypodens = low density of the structure). Contrast medium (see: MRI with contrast medium – is it dangerous?) is also normally used to produce an MRI image if the presence of a brain abscess is suspected. Magnetic resonance imaging (MRI of the head) has a higher diagnosis rate than computed tomography, especially in the early stage – the formation of abscesses – and can therefore be used for early detection.In addition to CT and MRT imaging, the examining physician also has access to a special scintigraphy and the EEG (electroencephalogram) for making a diagnosis.

Therapy

In the early stages of a brain abscess there is no capsule around the inflammation. Therefore, the therapy is initially started with an intensive administration of antibiotics. If a capsule has already formed around the brain abscess or if the disease process continues despite antibiotics, drug treatment is no longer sufficient.

The brain abscess is punctured (punctured) with millimeter precision using a state-of-the-art surgical procedure (stereotactic puncture) in order to relieve pressure on the one hand and to create a drainage, a tube-shaped outlet for pus, on the other. Surgical removal of brain abscesses (total exstirbation) with opening of the cranial bone (craniotomy) is only considered if the position is very superficial, but may also be absolutely necessary if, for example, there is a foreign body (bone splinters, metal part, etc.) in the abscess capsule.

This may be the case after an injury to the head. Before and after any surgery, the patient is given high doses of antibiotics to prevent the spread of the inflammation and to kill the causative pathogens. If the antibiotics are not specifically adapted to the pathogen, three different antibiotics are normally used: Metronidazole, a 3rd generation cephalosporin and an antibiotic against staphylococci such as methicillin or vancomycin. Vancomycin is mainly used when a multi-resistant strain of bacteria is suspected, for which many other antibiotics would have no effect.