Brain abscess physical examination: Difference between revisions

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Latest revision as of 20:41, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farwa Haideri [2]

Overview

Patients with brain abscess generally appear healthy. Most findings are neuromuscular in nature.

Physical Examination

Appearance of the patient

The patient generally appears healthy, though may show signs of fatigue, drowsiness, or have speech difficulties.^[1]

Vital signs

Dysarthria
Fevers
Headache
- Most common complaint, seen in greater than 75% of patients

Neck

Stiffness in neck (in occasional cases)

Neuromuscular

Altered mental status
Hemiparesis
- Approximately 30-50% of patients will have focal neurological deficits
Eventual coma
Aphasia
Ataxia
Signs of increased ICP (N/V, lethargy etc.)^[1]
- This is an indication for immediate intervention.

References

↑ ^1.0 ^1.1 "Brain Abscess | Columbia Neurosurgery".

Template:WH Template:WS

[urlBrain_Abscess_|_Columbia_Neurosurgery-1] 1.0 ^1.1 "Brain Abscess | Columbia Neurosurgery".

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{CMG}}
+{{CMG}}; {{AE}} {{FH}}
 {{Brain abscess}}
 ==Overview==
+Patients with brain abscess generally appear healthy. Most findings are neuromuscular in nature.
 ==Physical Examination==
-The symptoms of brain abscess are caused by a combination of increased [[intracranial pressure]] due to a space-occupying lesion ([[headache]], [[vomiting]], [[confusion]], [[coma]]), [[infection]] ([[fever]], [[fatigue]] etc.) and focal neurologic brain tissue damage ([[hemiparesis]], [[aphasia]] etc.). The symptoms and findings depend largely on the specific location of the [[abscess]] in the brain. An [[abscess]] in the [[cerebellum]], for instance, may cause additional complaints as a result of [[brain stem]] compression and [[hydrocephalus]]. [[Neurological examination]] may reveal a stiff neck in occasional cases (erroneously suggesting meningitis). The famous triad of [[fever]], headache and focal neurologic findings are highly suggestive of [[brain abscess]] but are observed only in a minority of the patients.<ref> Brain Abscess. Wikipedia (2015). https://en.wikipedia.org/wiki/Brain_abscess#Signs_and_symptoms Accessed on October 7, 2015</ref>
+===Appearance of the patient===
-The most frequent presenting symptoms are:<ref> Brain Abscess. Wikipedia (2015). https://en.wikipedia.org/wiki/Brain_abscess#Signs_and_symptoms Accessed on October 7, 2015</ref>
+* The patient generally appears healthy, though may show signs of fatigue, drowsiness, or have speech difficulties.<ref name="urlBrain Abscess | Columbia Neurosurgery">{{cite web |url=http://www.columbianeurosurgery.org/conditions/brain-abscess/ |title=Brain Abscess &#124; Columbia Neurosurgery |format= |work= |Accessed on October 30, 2015=}}</ref>
+===Vital signs===
+*[[Dysarthria]]
+*[[Fevers]]
 *[[Headache]]
-*[[Drowsiness]]
+**Most common complaint, seen in greater than 75% of patients
-*[[Mental confusion|confusion]]
-*[[Seizure]]s
+===Neck===
+* Stiffness in neck (in occasional cases)
+===Neuromuscular===
+*[[Altered mental status]]
 *[[Hemiparesis]]
-* Speech difficulties and fever
+** Approximately 30-50% of patients will have focal neurological deficits
+*Eventual [[coma]]
-As a summary the presenting signs and symptoms relate to the size and location of the [[abscess]] and the virulence of the bug.
+*[[Aphasia]]
-* [[Headache]] is the most common complaint, seen in greater than 75% of patients.
+*[[Ataxia]]
-:* There are no specific descriptors of an abscess headache accounting for one of the factors that often delays the diagnosis.
+* Signs of increased [[ICP]] (N/V, [[lethargy]] etc.)<ref name="urlBrain Abscess | Columbia Neurosurgery">{{cite web |url=http://www.columbianeurosurgery.org/conditions/brain-abscess/ |title=Brain Abscess &#124; Columbia Neurosurgery |format= |work= |Accessed on October 30, 2015=}}</ref>
-:* The BA is usually not severe, unless the [[abscess]] ruptures into a ventricle, at which time [[meningismus]] and death often develop as well.
+** This is an indication for immediate intervention.
-:* The classic triad of BA, [[fever]] and a focal neurologic deficit are seen in < 50% of cases.
-* Signs of increased [[ICP]] (N/V, [[lethargy]] etc.) can be seen in up to 50% of patients, and is usually an indication for immediate intervention.
-:* [[Papilledema]], however, is seen in < 25% of cases.
-* [[Fever]] is present in 40 – 50% of cases, and hence its absence should not be used to exclude the Dx.
-* Approximately 30 - 50% of patients will have focal neuro deficits (most commonly hemiparesis).
-* 25% of patients present with new-onset [[seizure]]s.
 ==References==
 {{Reflist|2}}
+{{WH}}
+{{WS}}
 [[Category:Disease]]
+[[Category:Up-To-Date]]
 [[Category:Neurology]]
+[[Category:Neurosurgery]]
+[[Category:Emergency medicine]]
 [[Category:Infectious disease]]
-[[Category:Neurosurgery]]
-[[Category:Needs overview]]
-{{WH}}
-{{WS}}