BRAIN ABSCESS Brain abscess is a not uncommon disease in childhood.
The causes are head injuries, diseases of the ears, nose or other structures of the head, suppuration in distant organs and general sepsis.
We accordingly distinguish traumatic, otogenic, rhinogenic and metas tatic abscesses. When no cau.se can be discovered, the term idiopathic abscess is used. Abscesses occurring as sequels of suppuration or acute inflammatory diseases of the meninges or of the blood vessels must be regarded as symptoms of this disease and therefore require 110 further discussion in this place.
With regard to the frequency of brain abscess in childhood, Cowers found that of 223 cases, 24 occurred during the first, and 4S during the second decade of life. Holt collected 27 eases, most of them in infants, although during the earliest years of life the tendency is rather toward general suppurative meningitis than toward brain abscess. Of the various forms of brain abscess the otogenic and traumatic are the most common in childhood. "Idiopathic" ab.seesses not infrequently occur in children and are probably due to a former unrecognized septic process.
abscess is the result of acute inflammation of the brain. The tissue in the centre of a diseased focus breaks down or undergoes rapid suppuration; the resulting cavity is at first irregular in outline and contains greenish yellow, fetitl pus, mas.ses of necrotic brain tissue, sometimes fluid, and always bacteria. In addition to the pus producing organisms—streptococcus and staphylococcus—there are found, among others, pneumococcus. pyocyaneus and in a few cases the tubercle bacillus (Frankel). The abscess grows very rapidly and inay be as large as a pea or occupy an eutire hemisphere. After a time, (from two to three weeks in traumatic abscesses, Lebers) the pus cavity becomes surrounded by a membranous capsule, which is usually smooth and vascular and varies in thickness up to 5 millimetres according to the duration of the abscess. As the abscess becomes encapsulated it assumes a more spherical shape. The development of a capsule does ttot necessarily imply that the disease has become arrested, for it may remain latent for a long time (28 years in the case of traumatic abscess, Nauwerk). Otitic abscesses remain latent at most years (Maciewen).
Not infrequently- the abscess connects by fistula with the surface of the brain or a diseased portion of the skull. The brain substance in the
immediate neighborhood of the abscess usttally exhibits inflammation and softening: large abscesses cause pressure symptoms in distant portions of the brain, flattening of the convolutions and internal hydrocephalus.
The different varieties of brain abscess present certain special features. Traumalie brain abscess is almost always solitary and is usually situated in the cerebrum, more rarely in the cerebellum. It may remain latent for years. Otitir brain abscess occurs chiefly as the result of chronic suppurative catatTh of the middle ear (cholesteatoma, polypi), the morbid process beginning in the bone and involving the (tura secondarily. It is situated in the temporal lobe (usually on the right side, korner), or in the cerebellum. According to Korner 82 per cent. of otitic brain abscesses in children occur in the cerebrum and 10 per cent. in the cerebellum. In adults the proportion is 63 per cent. in the cerebrum and :37 per cent. in the cerebellum. The abscess is usually solitary and may attain a considerable size, particularly in the temporal lobe. The abscesses which rarely follow suppurations in the nose and in the orbital cavities are usually situated in the frontal lobes. Metastatic abscesses are particularly frequent in children. The primary disease may be a putrid affection of the lungs (bronchiectasis, gangrene of the lung, sometimes ulcerous tuberculosis), more rarely suppurative peritonitis; thrush even is given as the cause in few cases (Zenker, Wagner). Metastatic abscesses are almost always multiple. They exhibit a predilection for certain portions of the brain and, in addition to putrid pus. occasionally contain some of the structural elements of the primary focus (pignaent from the lungs). So-called injectious abscesses are sometimes seen after cerebrospinal meningitis, typhoid fever and influenza and have a similar significance, In a good many of these cases an otitis probably represents the connecting link. The occurrence of primary idiopathic brain abscess is quite properly doubted by many authorities (Huguenin, v. Bergmann, Broca and others), particularly as a long interval of time may elapse between the primary suppuration and the appearance of the abscess. Martins believes that a primary abscess may be produced by a bacterial cause of cerebrospinal meningitis.