Cerebral Abscess can damage Brain Functions

Chhatra Karki, CNS Correspondent, Nepal
Are you suffering from an ear-abscess? Be careful if you have not undergone treatment for a long time. Delay in treatment can cause the pus from the abscess to spread all over the head and result in a cerebral abscess. Heart problems can further compound the risks.

Dr Yam Bahadur Rokka, Senior Neurologist of Neuro Hospital, Biratnagar, Nepal, says that this problem can also be observed in people who have met with an accident as unwanted substances like pebbles, mud or bullets may find their way to the head through the bruises and wounds from the accident and cause infection in the brain. Thus bacterial or fungal infection, and pus or other unwanted material getting amassed in the brain can cause this problem. Moreover, pus clotted in any part of our body may transfer to the brain through blood. The major reason for this disease is solely due to delayed treatment of ear-infection, heart disease and other infections.

Severe headache, fever, nausea, poor eye sightedness, fainting and epilepsy are symptoms of this disease. Specialists say that in 25% of patients cerebral abscess is mainly caused due to infection of sinuses, middle ear, teeth and mastoid. The bacteria from the infected parts reaches the brain through emissary veins and causes the disease.

The disease, which was identified in 1867 for the first time in the world, can be cured both medically and surgically. It can be diagnosed through laboratory tests of ear-infection or the clot of pus in the body. The pus amassed in the brain can be released either through endoscopic surgery or various other methods. Different approaches for treatment can be applied, depending upon the nature and severity of the problem like small abscess, deep multiple abscess, and/or abscess with meningitis.

According to Enzmann et al (1983), the abscess goes through four radiological stages, and ultimately becomes fatal when it forms a capsule after the infection. Among the four stages, the first stage is known as early cerebritis (inflammation of the cerebrum), which develops within one to three days. It further develops into a ring of inflammatory cells at late cerebritis stage after four to nine days.  Gradually the ring forms a thick capsule after 10 to 14 days. Furthermore, it grows to a thicker wall at late capsule stage after 14 days, and this is a traumatic and precarious stage. At this juncture normal brain parenchyma (functional parts) may be damaged.

According to Dr. Rokka, delayed treatment may cause the disease to spread over to other body parts as well. And the more it spreads, the riskier it becomes. Eventually the bubbles of pus clots in the head burst. He advises immediate treatment of clotting of pus due to accidents, ear-infections, and oral infections in order to be free from the risk of cerebral abscess. Dr. Rokka informs that cerebral abscess is more common in people below 25 years of age, particularly in children and youth.

This disease is said to affect 10%-15% people in developing countries, mainly in poor settlements, which have poor medical care facilities whereas its occurrence is very rare in developed countries. The Health Service Department of Government of Nepal still does not have any reliable data of people suffering from this disease. Cases of cerebral abscess do not seem to be common in Nepal and treatment is also offered in hospitals, but the expenses vary according to the severity and the stage of development of cerebral abscess. According to Dr. Lakhanlal Shah, Director General of Health Service Department of Government of Nepal, the burden of expenditure is less in government hospitals in comparison to private ones. According to him, a patient of this disease should take drugs prescribed for 6 to 8 weeks. In case of surgery, the patient should normally stay at hospital for 8 to 10 days.

Awareness and education, and access to hospitals and modern technologies are helpful to prevent and cure the disease. Till about 10 years back nearly 60% of the patients suffering from cerebral abscess would succumb to it globally. But with better medical facilities available now, death rates have gone down to 10-20%.

Even though there is an affluent infrastructure in the big hospitals of Nepal like Bir Hospital and some other teaching hospitals for the treatment of this disease, yet the Government of Nepal has not yet introduced any projects for systematic research on this disease. Also because of insufficient number of neurosurgeons (only 22 in entire Nepal), treatment is not still easily accessible. But treatment is expected to become increasingly effective with more and more technological advancements. But it is essential to increase the level of awareness among the health practitioners working in hospitals, health posts and private health service institutions so that it becomes easier to educate the general public about the disease and avoid the risks.

Chhatra Karki, Citizen News Service - CNS 
25 October 2014