Brain Abscess 

Collection of pus inside a closed capsule is known as an abscess. Brain abscess occurs in the brain.



Collection of pus inside a closed capsule is known as abscess. It can be found in any part of the body. It usually results from an infection present in the same organ. But on occasions, the infection can spread from another part of the body.

Compared to abscess in other parts of the body, abscess in the brain is considered very serious. Despite the improved treatments available today, 5% to 10% patients affected by a brain abscess may die.

Unfortunately, this disease is very common in India.

Causes of Brain Abscess

Infection from surrounding areas may spread via blood, lymph (a fluid that cleanses the body from infection), or by direct extension and settle down in the brain, to form an abscess. They include:

  • Ear Infection

    Untreated ear infection can gradually seep into the brain, forming a brain abscess. In India, this is the cause of more than 50% of the brain abscess.

  • Sinusitis

    Sinuses are empty air spaces in the skull that make the skull feel light. Sinuses also secrete mucous, which helps in keeping the nose moisturized. Any infection in th enose or sinus can enter the brain and result in abscess formation.

  • Tooth Infection

    Infection in the teeth can quickly spread to the brain. Hence, teeth infections must be attended to immediately.

  • Meningitis

    This is a common bacterial infection of the brain, usually seen in children. Very rarely, this can also be a source of brain abscess.

Here are few other assorted causes of a brain abscess:

  • Open Head Injuries

    When an open head injury happens, pieces of bone, hair and dirt particles can get inside the head. If these particles are not properly washed away through a surgery, they act as a focus of injection. In the course of many years, they form a brain abscess.

  • Metastatic Abscess

    Microorganisms from other parts fo the body (chest, skin, bone, abdomen, etc.) can travel through the blood, get lodged in the brain and form an abscess. This is more common in people with an odd heart condition wherein their blood bypasses the filteration by lungs.

  • Cryptogenic Abscess

    Crypto = Uknown. Genic = Of origin. In some cases, the source of a brain abscess may not be identifyable. These cases are called Cryptogenic Abscess.

  • Post-Operative Abscess

    Improper healing of surgical wounds after a brain surgery can result in a brain abscess formation.

Complication due to Brain Abscess

Epilepsy is a common complication of brain abscess. So, all patients with a brain abscess are given anti-seizure drugs for at least 1 to 2 years after the treatment for the abscess has ended.

Symptoms of a Brain Abscess

Symptoms of a brain access depend on the size, location and number of abscesses, on the virulence of the micro organism forming the abscess and the immune power of the affected individual.

Here is the long list of common symptoms seen in individuals with Brain Abscess. The exact symptom seen in an individual depends on the part of the brain affected by the abscess:

  • Headache
  • Seizures
  • Inability to move one or more parts of the body
  • Improper co ordination or gait
  • Speech problems
  • Visual problems
  • Nausea
  • Vomiting
  • Mild confusion to coma, depending on severity of infection
  • Bulged out eyes, which is often a late sign. It indicates increased pressure inside the brain.

In infants, the usual presenting signs are as follows:

  • Enlarging head
  • Bulging fontanelle
  • Separation of sutures
  • Vomiting
  • Seizures
  • Irritability
  • Poor feeding

Diagnosis of a Brain Abscess

The only useful blood test to ascertain the presence of a Brain Abscess is an elevated CRP (C-Reactive Protein). But elevated CRP only says that there is an infection somewhere in the body. Additional imaging studies are required to pin point the infection to a brain abscess.

Here are usual imaging studies carried out to study a brain abscess:

  • Skull X-Ray

    Infection of the sinuses and ear infection, which often result in a brain abscess, can be easily seen in a skull X-Ray. Also, presence of air inside the skull, if seen, indicates brain abscess that has resulted in prior traumatic event.

  • Skull CT Scan

    A CT scan can provide information like the stage of the abscess, number of abscesses, incresed intracranial pressure, surrounding infection, etc.

  • MRI of the Brain

    MRI is more sensitive than a CT scan in identifying an abscess in its earliest stage.

  • Magnetic Resonance Spectroscopy (MRS)

    MRS is a newly emerging diagnostic tool. It can tell between a brain abscess and other type of brain tissue damages.

Treatment for the Brain Abscess

Depending on age, neurological condition, location, number, size and severity of the abscess, the doctor decides whether to go for a medical or surgical treatment option.

Medical Treatment

Small abscesses in its early stages can be treated with antibiotics. After a treatment round, a follow up CT scan is usually advised to check for recurrence.

Surgical Treatment

When the brain abscess is estimated to be in an advanced stage or if it is through of life threatening, a surgery is performed to remove the abscess. Depending on the nature of the abscess, many surgical procedures have been described for the treatment of abscess.

Go here for more information on surgical treatment for the Brain Abscess

Treatment Window

Early diagnosis, appropriate treatment and proper control of the primary and secondary infection, helps achieve a good outcome and complete cure.

Till properly treated, bacteria causing the brain abscess literally eat into the brain.

Concussion of the Brain

“Concusses” in Latin means “action of striking together”. Damage caused to the brain by the head hitting against something hard is called the Concussion of Brain.


When the head strikes or struck by something very hard, it tends to move forward and backward or sideways. The force of the movement shakes the brain vigorously. This disrupts various energy and chemical pathways in the brain. The force also stretches and damages nerves in the brain, leading to momentary loss of consciousness, visual and memory problems or difficulty maintaining balance.

Usually, within seconds after the impact, the patient is back on their legs, but they have forgotten what happened to them. They might also find it difficult to remember any new information given to them. This is called retrograde and anterograde amnesia. Increased secretion of a chemical called acetylcholine is responsible for this. Acetylcholine in high quantities can block transmission of signals within the brain. So there is a temporary disruption of the signaling networks in the brain.

With time, as the acetylcholine levels fall down, and the signaling network is re-established. Usually, in less than two weeks, the amnesia resolves, and the patient recovers completely.

Complication due to Brain Concussion

Second Impact Syndrome: First incidence of traumatic concussion in a person resolves easily. However, the severity of concussion and its symptoms may worsen with successive injuries. This often happens to American Football players, boxers, etc. With repeated concussion, the changes in the brain can become permanent.Patients may suffer from memory loss, depression, difficulty in thinking and concentration.


Here are some of the typical symptoms of a brain concussion:

  • Brief loss of consciousness
  • Slow breathing
  • Weak pulse
  • Fall in blood pressure
  • Confusion
  • Headache
  • Short term memory
  • Mental disturbance
  • Dizziness
  • Blurred vision
  • Tiredness
  • Sluggishness
  • Difficulty concentrating
  • Irritability
  • Depression
  • Nervousness


Functional MRI (fMRI) is the best tool available for diagnosing a brain concussion.

  • Functional MRI and Blood Oxygen Level Dependent (BOLD) Activity

    Concussion mainly causes functional disturbances in the brain. MRI and CT scans almost always show normal brain picture. fMRI and BOLD Activity show increased activity in some brain areas and decreased activities in others. This helps a doctor/surgeon to identify the pattern of injury in the brain.

Treatment for Brain Concussion

Symptoms of a brain concussion resolve spontaneously in a week or two. However, till such time the concussion resolves, the patient may have to be kept under close observation to watch out for untoward deterioration.

Medical Treatment

Patients who suffer from symptoms giddiness, light-headedness, or difficulty in concentration are treated symptomatically, and nerve protective medications are given.

Surgical Treatment

A pure concussion resolves on its own and does not need any surgical intervention.

Treatment Window

When a concussion occurs along with other brain injuries, patient should be observed closely for deterioration and appropriate treatment must be initiated immediately, based on CT findings.

Brain Stem Hematoma

Brain stem manages many functions vital to sustaining life. So, blood leakage or blood clot here can be life threatening.


“Brain Stem” is the stem like portion of the brain at its lower most part, where the brain connects with the spinal cord. Brian Stem controls and regulates vital functions like breathing, heart rate, regulation of body temperature, etc. So, a hematoma here can be seriously life threatening.

Brain Stem Hematoma is also known as “Duret Hemorrhate”, after the surgeon who first identified it.

Causes of Brain Stem Hematoma

Here are some of the common causes of hematoma or hemorrhage in the brain stem

  • Head Injuries

    Cuts and bruises over the brain stem during a severe head injury can result in blood leakage (hemorrhage) and blot clotting (hematoma)

  • Neck Fracture

    In an automobile accident, passenger in the front seat can have their head violently bump against the dashboard of the car. This can cause a forward and backward movement of the neck at high force, resulting in the fracture of the neck. Such neck fractures almost always end up causing a brain stem hematoma.

  • High Blood Pressure

    High blood pressure can result in rupture of the blood vessels in any part of the body, including the brain stem.

Complication due to Brain Stem Hematoma

Brian stem controls and regulates breathing. As the blood leakage or blood clot in the brain stem worsens, the breathing first becomes irregular, then slows down and ultimately stops. So, patients with a brain stem injury often require external breathing support in the form of a mechanical ventilator.

Symptoms of a Brian Stem Hematoma

Brain stem hematomas usually occur along with brain injuries. Only when the trauma to the brain is so severe, the brain stem is also injured. So, this is a severely debilitating condition. Less than 25% of the patients are conscious when they are brought for medical help. Many of them are:

  • Unconscious
  • Unresponsive
  • Comatose
  • Have shallow/irregular breathing
  • Have increased body temperature

Investigations for a Brain Stem Hematoma

Here are the the most common tool used to diagnose a brain stem hematoma

  • CT Scan

    To identify a brain stem injure, CT Scan is the imaging technique of choice. With the help of a CT, it is possible to identify a brainstem hematoma within 4 to 8 hours of injury.

  • Cold Caloric Response

    In this test, cold water is poured in to the ear. This stimulates a nerve called the vestibular nerve, which connects the base of the brain to the ear. If the brain is functioning well, it responds by sending a signal to the eyes and rapid side to side movement is seen in both the eyes. If the rapid movement of the eyes is not seen, the brain stem is probably not functioning.

  • Brainstem Auditory Evoked Response

    Electrodes are placed under the skin of the scalp, and in front of the ears. A neurosurgeon reads the brain activity through the readings of the electrode. These readings can predict the degree of brain activity.

Treatments for Brain Stem Hematoma

Patients with a brain stem hematoma are very sick. They are likely to remain unconscious for a long period. They need:

  • Longer stay in ICU
  • Proper nursing care
  • Tracheostomy care
  • Management of temperature
  • Management of lung related issues

Medical Treatment

Patients being treated for brain stem hematomas are given medication to decrease the patient’s body temperature, seizure preventing drugs, and nerve protectors.

High dose of antibiotics may also be given to treat infections that may result from tracheostomy, lunc infection, urine infection and general infection.

All of these lead to longer hospital stay.

Surgical Treatment

Surgeries in the brain stem have very low success rate. So, surgeries to remove bleed in the brain stem are not recommended. However, surgeries may be conducted to treat brain injuries in other parts of the brain or to enable artificial breathing through a tracheostomy.

Treatment Window

As mentioned earlier, brain stem hematoma is a life threatening condition. An immediate CT scan, early diagnosis and close follow dramatically increase the survival rate of the patient.

Brain TB (Tuberculosis) 

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mybacterium Tuberculosis (MTB). It usually affect the lungs. With time, the bacterium can spreads to other parts of the body including the brain. TB can affect people all ages and sexes.


In the brain, tuberculosis forms what we call a tuberculoma. Tuberculomas vary in size and shape. They may be single or multiple. In the mature form, a tuberculoma is firm, hard to touch, and grayish-yellow in color. Tuberculoma usually does not contain any blood vessel. A capsule of tuberculoma is a piece of compressed, damaged brain tissue. A neurosurgeon’s job is to take out these tuberculomas.

Types of Tuberculoma

If the TB proves difficult to deal with medically, then a neurosurgeon works on physically removing the tuberculomas from the brain. To do that, it is important to know what kind of tuberculoma one is dealing with.

  • Tuberculoma en plaque

    This tuberculoma looks like a plaque. This type of tuberculoma has increased blood vessels (other tuberculomas don’t have blood vessels). Surgeon must keep this in mind while removign the plaque-like tuberculomas.

  • Tuberculous Abscess

    These tuberculomas contain pus and resemble a brain abscess. This type of tuberculoma is common in India

  • Cystic Tuberculoma

    These tuberculoma are in the form of a cyst. They are filled with clear yellow or cloudy green fluid, depending on the stage of infection. These tuberculomas are relatively rare.

  • Multiple Grape-like Tuberculomas

    Very rarely, multiple, immature tuberculomas are observed. They group together, resembling a cluster of grape.

  • Mictotuberculomas

    This type of tuberculoma is seen as a small disc or ring around 5mm to 7mm in diameter. These are common in India.

  • Calcified Tuberculomas

    With time, a tuberculoma can calcify into a hard mass. Although calcified, they are still infectious.

  • Tuberculous Encephalopathy with an “Inconsequential” Tuberculoma

    Sometimes, brain damage is seen in children with a small or no lession at all. This is usually because of an allergic reaction to some proteins relseased by the TB bacteria. In these cases, a biopsy of the brain tissue usually help to confirm the presence of TB.


Here are some of the common symptoms of Brain TB:

  • Fever
  • Seizures
  • Headache
  • Vomiting
  • Nausea
  • Gait problems
  • Speech Disturbances
  • Vision Problems
  • Weakness
  • History of exposure to lung TB
  • Evidence of TB elsewhere in the body


Here is the usual set of investigations carried out to find out of one has TB and how it has affected the body.

  • Blood Test

    ESR (Erythrocyte Sedimentation Rate) is usually raised when there is any kind of infection in the body, including TB. So, a doctor orders a blood test to determine the ESR. But TB is a tricky one. One can have TB even with normal ESR.

  • Mantoux Test

    A protein component of TB bacteria is injected into the skin of the forearm. If one has TB, the injection site becomes red in color. Trouble with this test is that it can give false-positive results.

  • Chest X-Ray

    TB very rarely occurs without a lung infection. So, when the doctor suspects presence of TB, they always order a Chest X-Ray to determine if there is evidence of TB in the lungs.

  • CT of the Brain

    CT imaging of the brain helps the doctor/surgeon to idenitfy she size, shape, location and number of lesions (damaged patches of tissue) in the brain. CT can also visualize calcification clearly.

  • MRI of the Brain

    MRI images help the doctor/surgeon to see the stages of brain lesions clearly.

  • Stereotactic Biopsy

    Under the CT guidance, using a fine needle, a small portion of the affected brain tissue (lesion) is taken out and studied under a microscope. This help in definitive diagnosis of TB in the brain.

Treatment of the Brain TB

Doctors usually prefer to deal with TB medically. When that fails, or when the TB has already spread dangerously, a decision to surgically remove the TB affected tissue is preferred.

Medical Treatment

Medication that kill or stop the growth of TB bacteria are known as anti0tubercular drugs. Usually, an anti-tuberculor drug, combined with steroidal medications, lead to healing of the TB affected tissue in 10 to 12 weeks’ time. If the patch of affected tissue is large, then complete healing might take up to 6 to 8 months.

Surgical Treatment

  • Small and easily accessible tuberculomas (tissue hardened by TB) can be removed by excision.
  • With large tuberculomas, an ultrasonic aspirator (or CUSA) is used to suck out the TB affected tissue, without affecting the surrounding normal area.

Go here for more information on surgical treatment of Brain TB.

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