FortifyMDCerebral abscess
Suspect this in any patient with increased ICP, especially if there is fever or increased TLC. It may follow ear, sinus, dental, or periodontal infection; skull fracture; congenital heart disease; endocarditis; bronchiectasis. It may also occur in the absence of systemic signs of inflammation.
Suspect this in any patient with increased ICP, especially if there is fever or increased TLC. It may follow ear, sinus, dental, or periodontal infection; skull fracture; congenital heart disease; endocarditis; bronchiectasis. It may also occur in the absence of systemic signs of inflammation.
Investigations
CT/MRI(e.g. ‘ring-enhancing’ lesion)CBCESRBiopsy
Treatment
- Urgent neurosurgical referral
- Treat increased ICP (see ICP article)
- If frontal sinuses or teeth are the source, the likely organism will be Strep. milleri (microaerophilic), or oropharyngeal anaerobes.
- In ear abscesses: B. fragilis or other anaerobes are most common.
- Bacterial abscesses are often peripheral
- toxoplasma lesions are deeper (e.g. basal ganglia).
- If immunocompromised, Discuss with infectious diseases/microbiology.
Cardiogenic shock
Cardiogenic shock is a state of inadequate tissue perfusion primarily due to cardiac dysfunction. It may occur suddenly, or after progressively worsening heart failure.
Chronic Obstructive Pulmonary Disease (COPD)
A common progressive disorder characterized by airway obstruction (FEV1 <80% predicted; FEV1/FVC <0.7; see p162 and table 4.5) with little or no reversibility. It includes chronic bronchitis and emphysema.