21 Neurosurgery MCQs Answers

Answer: b, d, e

A brain abscess is a purulent lesion of brain tissue, beginning as a focal infection, usually in the white matter surrounded by a typical inflammatory response. Brain abscesses usually are secondary to focal infection elsewhere. Abscesses that develop by direct intracranial extension are usually solitary and are typically found in the frontal and temporal lobes. Multiple brain abscesses that develop in the septic patient are often related to bacterial endocarditis, pneumonia, and diverticulitis. Abscess formation is frequent among patients with compromised immunity either from an underlying illness or during pharmacologic immunosuppression (i.e., during organ transplantation). Signs and symptoms of brain abscess are related to its mass effect. Headache, focal neurologic deficits, and impaired mentation are often noted. There may be little or no evidence of infection and the patient may be afebrile. Seizures may occur. Intracranial epidural abscesses are quite uncommon and are usually caused by a local extension of osteomyelitis or by hematogenous spread from a distant suppurative focus.

In cases of early abscess formation or high surgical risk, medical therapy alone with the appropriate parenteral antibiotic may be sufficient. The most effective therapy is drainage of the purulent material with simultaneous administration of appropriate intravenous antibiotics. Although needle aspiration may be successful, craniotomy with evacuation and removal of the abscess wall may be necessary. Surgical drainage reduces the mass effect, thereby reducing the most critical and dangerous aspect of the infection. It also allows accurate bacteriologic analysis. Despite aggressive surgical and medical management, mortality rates associated with brain abscess approach 40%, especially in the malnourished, chronically debilitated, or immunosuppressed patient.

Category: Surgery MCQs