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Neurosurgery Without TearsAntibiotics are the mainstay of treatment of bacterial meningitis. It is essential to use antibiotics which readily cross the blood brain barrier. The third generation cephalosporins are in wide use for the treatment of meningitis especially in adults.
Broad-spectrum agents are used initially, while specific drugs are commenced as soon as results of CSF analysis are [...]
Diagnosis
The definite diagnosis of bacterial meningitis is based on the findings of cerebrovascular fluid (CSF) examination. The CSF is obtained from lumbar puncture. The usual picture is pleocytosis with cell count over 1,000 cells per mm3 (with polymorphonuclear cells predominating), hypoglycorrhagia with glucose under 30 mg per dL and elevated protein usually over 200 mg [...]
The clinical features of acute bacterial meningitis vary with the age and immune status of the patient. Children may present with fever, convulsions, refusal of feeds, irritability, excessive cry and vomiting. Adults may present with fever, headache, vomiting, lethargy, confusion, and a stiff neck.
The manifestations, however, may be subtle, especially in newborns, immunosuppressed patients, and [...]
The causative organisms of acute bacterial meningitis are clearly associated with the age of the patient. The common organisms in each age group are as detailed below:
Neonatal period: Escherichia coli, group B streptococci (S. agalactiae), and L. monocytogenes.
Ages 2 months to 5 years: H. influenzae
Above 5 years: S. pneumoniae and N. meningitidis.
In addition [...]
This is a medical emergency.
Meningitis is the inflammation of the meninges, the coverings of the brain and the spinal cord: dura, arachnoid, and pia. It carries a high mortality rate despite medical advances.
Meningitis may be caused by various agents including trauma, chemicals e.g released from tumours and several infectious agents. However, bacterial meningitis represents the [...]
Management of brain abscess has witnessed tremendous improvements in recent times. In the pre-antibiotic era, the condition is almost uniformly fatal. However, with the introduction of antibiotics into surgery, the outlook for brain abscess, like other intracranial infection, has remarkably improved.
The most important single contribution to the present improved prognosis is the introduction of computed [...]
A high index of suspicion is necessary to make an early diagnosis of cerebral abscess. Clinical presentation of cerebral abscess usually take the following pattern:
short clinical course, usually days, as opposed to tumours that run a longer course, usually months/years
Predominant symptom: headache (70-95% of cases)
Alteration in mental status
Focal neurological deficits (such as hemiparesis, aphasia, visual [...]
In the preantibiotic era brain abscess was caused predominantly by Staph. aureus and streptococci. After the introduction of antibiotics the incidence of staphylococcal abscesses declined and most abscesses were thought to be due to streptococci, although up to 50% of culture results in some series were ‘sterile’.
With advancements in microbiology that has led to improved [...]
Neuroimaging is very essential in the diagnosis of a brain abscess. Radiographs may show depressed skull fractures, intracranial foreign bodies or fluid in the paranasal sinuses when these are present but is otherwise not useful for diagnosis.
The introduction of computed tomography brought about the most important single advancement in the management of intracranial infections especially [...]
Pyogenic inflammation of the brain leading to cerebral abscess may result from:
direct spread from an adjacent focus of infection such as sinusitis, otitis or dental infections. The infection usually involve the adjacent part of the brain. As such, frontal sinusitis affects the frontal lobe while otitis spread to the temporal lobe. They are usually [...]
