Complications
Caused by rupture of the abscess into the ventricular system. This may occur spontaneously or at the time of surgery. Generally requires treatment with intrathecal antibiotics and may be complicated by hydrocephalus. Outcome in this subgroup of patients is often poor with a significantly increased mortality.[55]
May occur as a result of cerebral salt wasting or the syndrome of inappropriate antidiuretic hormone (SIADH). Daily serum electrolyte analysis in ICU patients with periodic monitoring thereafter is necessary. A drop in the serum sodium level should prompt an evaluation for the presence of SIADH, with fluid restriction if confirmed. Hyponatraemia must not be corrected over-aggressively (no more than 12 mEq daily) to avoid central pontine myelinolysis.
A high risk of reduced cognitive performance has been shown in children with cyanotic heart disease and in neonates with brain abscess.[1]
It is difficult to distinguish the relative effects of prematurity, prolonged ICU care, underlying disorders, and brain abscesses themselves in the evolution of this complication.
Seizures are a relatively frequent complication and are treated with anticonvulsant drugs. All patients with brain abscess should be monitored for signs of seizures. In ICU patients with a depressed mental status, 24-hour electroencephalographic monitoring should be considered to exclude sub-clinical seizures.
Hydrocephalus is a rare presentation of brain abscess. More commonly hydrocephalus occurs after abscess complicated by ventriculitis. Hydrocephalus is treated by cerebrospinal fluid (CSF) diversion, which is initially by placement of an external ventricular drain, followed by internalisation (e.g., placement of ventriculoperitoneal shunt) when the CSF has been documented to be sterile for at least 1 week.
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