Published on March 12, 2014
Etiology Organism: Streptococcus; Klebsiella , Staphylococcus aureus, and anaerobes. In immunocompromised patients, it is important to include Toxoplasma, and Nocardia as possible etiologic agents, as well as fungal pathogens. Source: Classically, these abscesses arise locally from otorhinolaryngeal infections like (Sinus, ear, dental infections ) Or Hematogenously from distant infections. Or Head trauma( blunt, penetrating ,surgical)
Clinical picture Headache, nausea, vomiting, and altered mental status can occur due to increased intracranial pressure, while unilateral headache, seizures, and many focal neurological deficits occur due to the presence of a mass lesion. Fever and nuchal rigidity are also seen in many cases. Investigation The key to diagnosing brain abscess is correlating the clinical scenario with an imaging study, such as contrast-enhanced CT or MRI. The classic finding on CT or MRI is a circular lesion with a strongly contrast-enhancing surround rim.
Treatment Treatment should also be aimed at correcting the primary source of infection . Initial surgical treatment usually consists of needle aspiration of the abscess. A total excision can be performed if the abscess is chronic, and encapsulated . Antibiotic therapy typically consists of 6 to 8 weeks of intravenous treatment followed by 4 to 8 weeks of oral treatment. Patients should receive routine follow-up imaging and should also be started on an antiepileptic medication. Glucocorticoids should be considered to counteract symptomatic intracranial hypertension, although their role is less important than in the treatment of brain tumors.
Introduction Neuralgia Unexplained peripheral nerve pain The most common site: head and neck The most frequently diagnosed form: trigeminal neuralgia (TN) Female predominance (male : female = 1:2)
Characteristics of trigeminal neuralgia paroxysms of severe, lancinating , electric shock-like bouts of pain restricted to the distribution of the trigeminal nerve Unilaterally The mandibular and/or maxillary branch or, rarely, the ophthalmic branch
Spontaneous attacks or triggered by trigger zone & movement of the face Seconds to minutes. During an attack of TN, the sufferer will almost always remain still and afraid from speech or movement of the face, so as not to trigger further attacks of pain.
Pathogenesis of trigeminal neuralgia Traumatic compression of the trigeminal nerve by neoplastic (cerebellopontine angle tumor) or vascular anomalies Infectious agents Human herpes simplex virus (HSV) Demyelinating conditions Multiple sclerosis (MS)
Treatment Medical treatment Carbamazepine (Tegretol) – first line Oxcarbaazepine Gabapentin (Neurontin) Lamotrigine Baclofen Phenytoin Clonazepam Valproate Mexiletine Topiramate Second line Others
Surgical treatment Gasserian ganglion-level procedures Microvascular decompression (MVD) Ablative treatments Radiofrequency thermocoagulation (RFT) Balloon compression (BC) Stereotactic radiosurgery (SRS) Peripheral procedures Peripheral neurectomy Cryotherapy (cryonanlgesia) Alcohol block