脑脓肿

A brain abscess is a pocket of infection (a “ball of pus”) inside the brain that swells and presses on nearby brain tissue, and it is considered a medical emergency. It usually comes from germs that spread from another infection in the body, like an ear, sinus, lung, or heart infection, or from a serious head injury or surgery.

1) What is this condition?

It is a swollen, pus‑filled pocket of infection inside the brain, surrounded by a wall of tissue.
It is caused by germs (usually bacteria, sometimes fungi) that reach the brain through the blood, nearby infections, or open injuries to the head.
It can cause headache, fever, confusion, weakness, seizures, or changes in speech, vision, or personality.

2) How serious is it?

It is life‑threatening if not treated quickly because swelling and pus raise pressure in the head and can damage or crush brain tissue.
It can be mistaken for a brain tumor on scans, so quick and accurate diagnosis is important.
Even with treatment, there is a risk of death and long‑term problems, especially if treatment is delayed or the person is already very sick.

3) Non‑surgical treatments

Strong “through‑the‑vein” medicines that kill germs (antibiotics or antifungals) for at least 4–8 weeks.
Medicines to prevent or treat seizures, reduce swelling around the brain, control pain, and lower fever.
Care in the hospital, often in intensive care, to watch closely for changes in thinking, movement, or pressure in the head.
In some small abscesses (often under about 2 cm), careful treatment with medicines alone plus frequent brain scans may be tried.

4) Types of surgery that may be needed

Needle drainage (often called aspiration): a small hole is made in the skull, a needle is guided into the abscess with a scan, and the pus is drawn out.
Open surgery (craniotomy): a larger opening in the skull to drain or completely remove the abscess and its wall.
In rare or very complex cases, repeated drainage or special drainage systems with washing of the area may be used.

5) Goals of surgery vs non‑surgical care

Non‑surgical goals:
- Kill the germs causing the infection throughout the body and brain.
- Reduce swelling, prevent seizures, and protect brain function as much as possible.
Surgery goals:
- Remove or shrink the pocket of pus to relieve pressure on the brain.
- Get a sample of the pus to identify the exact germ so the right medicine can be chosen.

6) How surgery can “fix” the problem

Draining the pus lowers pressure inside the head and stops the abscess from getting bigger and causing more damage.
Removing or draining the abscess lets the medicines reach the area better and clear the remaining infection.
Taking a sample during surgery helps doctors match the medicine exactly to the germ, which improves the chance of cure.

7) Risks of surgery (general and specific)

General brain surgery risks: bleeding, infection, blood clots, reaction to anesthesia, and stroke.
Specific to brain abscess surgery:
- Leakage of brain fluid, new or worsening weakness, speech or vision problems, or seizures.
- Incomplete drainage, so the abscess may need another operation or may regrow.
- Spread or rupture of the abscess into the brain’s fluid spaces, which can be very dangerous.

8) Chances this surgery will work

With modern scans, surgery, and medicines, most people treated in time have good results; some series report around 70–90% recovering well.
The chances are better if the person is alert at the time of diagnosis, the abscess has not burst, and serious health problems are limited.
Outcomes are worse when diagnosis is late, there are many abscesses, or the person has a very weak immune system.

9) Possible complications from the surgery

New or lasting problems with movement, speech, vision, balance, or behavior if nearby brain tissue is damaged.
Seizures, which may require long‑term seizure‑prevention medicine.
Return of the abscess, need for repeat drainage, or spread of infection to the fluid around the brain or spinal cord.

10) Typical recovery from the condition

Symptoms like headache, confusion, or weakness often improve over weeks to months as the infection clears and swelling goes down.
Some people have lasting issues such as seizures, trouble with coordination, or personality and thinking changes, and may need rehabilitation.
Regular brain scans are done until the abscess has fully shrunk or disappeared.

11) Typical recovery after surgery

Expect several days (or longer) in the hospital while the brain and body are closely watched and medicines continue through the vein.
Tiredness, headaches, and slower thinking are common at first; many people gradually increase activity over several weeks.
Some will need physical, occupational, or speech therapy to regain strength, balance, daily skills, or communication and thinking abilities.

12) How long in the hospital

Many people stay in the hospital for several weeks for both surgery (if needed) and the early part of antibiotic treatment.
Total germ‑killing treatment usually lasts 4–8 weeks, often starting in the hospital and sometimes finishing at home or in a rehab facility with IV lines.
The exact length depends on how big the abscess was, how sick the person was at the start, and how quickly scans show improvement.

13) Long‑term outlook

Many people can recover fully or nearly fully, especially with early treatment and good overall health.
There is a higher long‑term risk of death and of developing epilepsy (repeated seizures) compared with the general population.
Ongoing medical care, seizure control, and rehabilitation can greatly improve quality of life for those with lasting problems.

14) Need for outpatient follow‑up

Regular follow‑up with brain specialists and infection specialists is essential to check symptoms, adjust medicines, and watch for seizures.
Repeat brain scans are done over time to confirm the abscess has fully cleared and has not come back.
Many patients also need ongoing therapy visits (physical, occupational, speech, or counseling) to help with movement, thinking, mood, and daily activities.