Lịch sử của viêm xoang, viêm tai giữa, viêm nội tâm mạc, nhiễm trùng phổi mãn tính, hoặc khuyết tật tim bẩm sinh phổ biến • Nhức đầu, các triệu chứng đầu mối thần kinh, co giật có thể xảy ra • Kiểm tra có thể khẳng định những phát hiện đầu mối • Các sinh vật phổ biến nhất là liên cầu khuẩn, | 310 Essentials of Diagnosis Treatment 12 Brain Abscess Essentials of Diagnosis History of sinusitis otitis endocarditis chronic pulmonary infection or congenital heart defect common Headache focal neurologic symptoms seizures may occur Examination may confirm focal findings The most common organisms are streptococci staphylococci and anaerobes toxoplasma in AIDS patients commonly polymicrobial Ring-enhancing lesion on CT scan or MRI lumbar puncture potentially dangerous because of mass effect Differential Diagnosis Primary or metastatic tumor Cerebral infarction Encephalitis Subdural empyema Neurosyphilis Treatment Intravenous broad-spectrum antibiotics with coverage to include anaerobic organisms may be curative if abscess smaller than 2 cm in diameter Surgical aspiration through burr hole if no response to antibiotic drugs either clinically or by CT scan Pearl Frank brain abscess is the least common neurologic manifestation of endocarditis. Reference Treatment of brain abscess. Lancet 1988 1 219. PMID 2893043 Chapter 12 Neurologic Diseases 311 Pseudotumor Cerebri Benign Intracranial Hypertension Essentials of Diagnosis Headache diplopia nausea Papilledema sixth nerve palsy CT scan shows normal or small ventricular system Lumbar puncture with elevated pressure but normal cerebrospinal fluid Associations include sinus thrombosis transverse or sagittal endocrinopathy hypoparathyroidism Addison s disease hyper-vitaminosis A drugs tetracyclines oral contraceptives chronic pulmonary disease obesity often idiopathic Untreated pseudotumor cerebri may lead to secondary optic atrophy and permanent visual loss Differential Diagnosis Primary or metastatic tumor Optic neuritis Neurosyphilis Brain abscess or basilar meningitis Chronic meningitis eg coccidioidomycosis or cryptococcosis Vascular headache migraine headache Treatment Treat underlying cause if present Acetazolamide or furosemide to reduce cerebrospinal fluid formation Repeat lumbar puncture with removal of .
