Introduction
A brain abscess is a pus-filled swelling in the brain caused by an infection. It is a rare and life threatening condition.
It happens when bacteria or fungi enter the brain tissue.
Symptoms of a brain abscess include:
Headache � which is often severe and cannot be relieved by taking painkillers
Changes in mental state such as appearing very confused
Weakness or paralysis on one side of the body
A high temperature (fever) of or above 38C (100.4F)
Seizures (fits)
What causes a brain abscess?
There are three main ways that a brain abscess can develop:
An infection in another part of the skull, such as an ear infection, sinusitis or dental abscess, spreads directly into the brain
An infection in another part of the body, such as the lung infection pneumonia, spreads into the brain via the blood
Trauma, such as a severe head injury, that cracks open the skull allowing bacteria or fungi to enter the brain
Although in around 1 in 7 cases the source of the infection remains unknown.
Treating a brain abscess
A brain abscess is regarded as a medical emergency. This is because the swelling caused by the abscess can disrupt the blood and oxygen supply to the brain. There is also a risk that the abscess may burst (rupture). If left untreated, a brain abscess can cause permanent brain damage and can be fatal.
A brain abscess is usually treated using a combination of antibiotics (or in some cases, antifungals) and surgery. Dr. B C Shah will usually open the skull and drain the pus from the abscess or remove the abscess entirely.
The sooner the condition is diagnosed and treated the lower the chance a person has of developing long-term complications.
Complications
Any damage to the tissue of the brain can result in long-term complications, such as:
Brain damage � which can range from mild to severe
Epilepsy � where a person has repeated seizures (fits)
Who is affected
Brain abscesses tend to only be significant problem in parts of the world where access to antibiotics is limited.
Brain abscesses can occur at any age, but most cases are reported in people aged 40 or younger. They are more common in men than women. It is not clear why this should be the case.
Outlook
Because of advances in diagnostic and surgical techniques, the outlook for people with brain abscesses has improved dramatically. Nowadays, deaths only occur in an estimated 1 in 10 of cases. Many people make a full recovery.
Symptoms of a brain abscess
The symptoms of a brain abscess can develop quickly or slowly.
In around two-thirds of people, symptoms are present for two weeks or less before they escalate to the point where the person needs to be admitted to hospital.
Common symptoms include:
Headache - the headache is often severe, located in a single section of the head and cannot be relieved with painkillers
Changes in mental state, such as confusion or irritability
Problems with nerve function, such as muscle weakness, slurred speech or paralysis on one side of the body
A high temperature (fever) of or above 38C (100.4F)
Seizures (fits)
Nausea and vomiting
Stiff neck
Changes in vision, such as blurring, greying of vision or double vision (because of the abscess putting pressure on the optic nerve)
When to seek medical advice
Any symptoms that suggest a problem with the brain and nervous system, such as slurred speech, muscle weakness or paralysis, or seizures occurring in a person who had no previous history of seizures should be treated as a medical emergency.
Any symptoms that suggest a worsening infection, such as fever and vomiting, should be reported to Dr. B C Shah immediately.
Causes of a brain abscess
An abscess is a pus-filled swelling caused by infection with either bacteria or fungi.
The abscess is created by your immune system as a defence mechanism. If the immune system is unable to kill an infection, it will try to limit its spread. Your immune system will use healthy tissue to form a wall around the source of infection to stop the pus infecting other tissue.
The routes for brain infection
Infections of the brain are rare because the body has evolved a number of defences to protect this vital organ. One of these is the blood-brain barrier, which is a thick membrane that filters out impurities from blood before allowing it into your brain.
However, in some people, for reasons not always entirely clear, germs can get through these defences and infect the brain.
The three most common routes for germs to enter the brain are:
Germs have already infected one of the nearby cavities in the skull (such as the ears or nose) and go on to infect the brain.
Germs have already infected another part of the body, get into the bloodstream, bypass the blood-brain barrier and then infect the brain.
Germs pass through the skull and enter the brain after the skull is damaged, for example after being hit by a blunt object or after a gunshot wound.
Though in around 1 in 7 cases no obvious cause for the infection can be found.
The causes of a brain abscess are explained in more detail below.
Germs from another infection in the skull
In up to a half of cases, the brain abscess occurs as a complication of a nearby infection in the skull, such as:
A persistent middle ear infection (otitis media)
Sinusitis (an infection of the sinuses, which are the air-filled cavities inside the cheekbones and forehead)
Mastoiditis (an infection of the bone behind the eye)
This used to be a major cause of brain abscesses, but because of improved treatments for infections, a brain abscess is now a rare complication of these kinds of infection.
Germs invading the brain through the bloodstream
Infections spread through the blood are thought to account for around 1 in 4 cases of brain abscesses.
People with a weakened immune system have a higher risk of developing a brain abscess from a blood-borne infection. This is because their immune system may not be capable of fighting off the initial infection.
You may have a weakened immune system if you:
Have a medical condition that weakens your immune system, such as HIV or AIDS
Receive medical treatment known to weaken the immune system, such as chemotherapy
Have an organ transplant and take immunosuppressant drugs to prevent your body rejecting the new organ
The most commonly reported infections and health conditions that may cause a brain abscess are:
Cyanotic heart disease, a type of congenital heart disease (a heart defect present at birth) where the heart is unable to carry enough oxygen around the body (this lack of a regular oxygen supply makes the body more vulnerable to infection)
Pulmonary arteriovenous fistula � a rare condition in which abnormal connections develop between blood vessels inside the lungs; this can allow bacteria to get into the blood and then into the brain,
Lung infections, such as pneumonia or bronchiectasis
Infections of the heart, such as endocarditis
Skin infections
Infections of the abdomen, such as peritonitis (an infection of the lining of the bowel)
Pelvic infections such as infection of the lining of the bladder (cystitis)
Germs invading the brain after a head injury
Direct trauma to the skull can also lead to a brain abscess and is thought responsible for 1 in 10 cases.
The most commonly reported causes include:
Skull fracture caused by penetrating injury to the head
Gunshot or shrapnel wound
In rare cases, a brain abscess can develop as a complication of surgery.
Diagnosing a brain abscess
An initial assessment will be made based on your physical symptoms and medical history, such as whether you have had a recent infection or a weakened immune system.
Blood tests
Blood tests will be carried out to check for the presence of infection. A high level of white blood cells in your blood indicates the presence of a serious infection.
Scans
If a brain abscess is suspected, the diagnosis can be confirmed using a brain scan.
Computerised tomography (CT) scan
A computerised tomography (CT) scan involves a series of X-rays taken of your body at different angles. This produces a detailed image of the inside of your body.
A CT scan can often detect the presence of the abscess and any associated swelling inside the brain.
Magnetic resonance imaging (MRI) scan
A magnetic resonance imaging (MRI) scan uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.
A MRI scan can provide a more detailed image than a CT scan so is sometimes used if the results of the CT scan are inconclusive.
CT-guided aspiration
If an abscess is found, Dr. B C Shah can use a CT scan to guide a needle to the site of the abscess and remove a sample of pus for further testing. This is known as CT-guided aspiration. The sample of pus should indicate the type of germ causing the abscess.
Treatment with broad-spectrum antibiotics will usually begin as soon as possible, even before a CT-guided aspiration is carried out, because it can be dangerous to wait for the results.
Broad-spectrum antibiotics can be used against a wide range of bacteria. They will be used before a specific diagnosis is made because there is a high chance they will be effective if the infection is caused by bacteria.
If the test reveals the abscess is caused by a fungus, the treatment plan can be changed and antifungal medication given.
Treating a brain abscess
Treatment for a brain abscess will depend on the size and number of brain abscesses present. A brain abscess is a medical emergency, so you will need treatment in hospital and will stay there until your condition is stable.
Medication
Surgery will be avoided if thought too risky or if an abscess is small and could be treated by medication alone.
Medication is recommended over surgery if you have:
Several abscesses
A small abscess (less than 2cm)
An abscess deep inside the brain
Meningitis (an infection of the protective membranes that surround the brain) as well as an abscess
Hydrocephalus (a build-up of fluid on the brain)
You will normally be given antibiotics or antifungal medication through a drip (directly into a vein). Dr. B C Shah will aim to treat the abscess and the original infection that caused it.
Surgery
If the abscess is larger than 2cm, it is usually necessary to drain the pus out of the abscess.
There are two surgical techniques for treating a brain abscess:
Simple aspiration
Craniotomy
Simple aspiration involves using a CT scan to locate the abscess and then drills a small hole known as a burr hole into the skull. The pus is then drained through the hole and the hole sealed.
A simple aspiration takes around one hour to complete.
Open aspiration and excisions are usually carried out using a surgical procedure known as a craniotomy.
Craniotomy
A craniotomy may be recommended if an abscess does not respond to aspiration or reoccurs at a later date.
During a craniotomy, Dr. B C Shah will shave a small section of your hair and then remove a small piece of your skull bone (a bone flap) to gain access to your brain.
The abscess will then be drained of pus or totally removed. A CT-guided localisation system may be used during the operation, which allows Dr. B C Shah to more accurately locate the exact position of the abscess.
Once the abscess has been treated, the bone is replaced. The operation usually takes around three hours which includes recovery from the general anaesthetic (where you are put to sleep).
Complications of a craniotomy
As with all surgery, a craniotomy carries risks, but serious complications are uncommon.
Possible complications of a craniotomy are:
Swelling and bruising around your face, which is common after a craniotomy. This will die down after the operation.
Headaches. These are common after a craniotomy and may last several months, but should eventually settle down.
A blood clot in the brain (further surgery may be required to remove it).
Stiff jaw. During a craniotomy, Dr. B C Shah may need to make a small cut to a muscle that helps with chewing. The muscle does heal, but can become stiff for a few months, causing your jaw to feel stiff. Exercising the muscle by regularly chewing sugar-free gum should help relieve the stiffness.
Movement of the bone flap. The bone flap in your skull may feel like it moves and you may experience a clicking sensation. This can feel strange, but it is normal and not dangerous. It will stop as the skull heals.
The site of the cut (incision) in your skull can become infected, although this is uncommon. You are usually given antibiotics around the time of your operation to prevent infection.
Recovering from surgery
Once your brain abscess has been treated, you will probably stay in hospital for several weeks so your body can be supported while you recover.
You will also receive a number of CT scans, to make sure the brain abscess has been completely removed.
Most people will then need a further 6 to 12 weeks rest at home before they are fit enough to return to work or full-time education.
After treatment for a brain abscess, avoid any contact sport where there is a risk of injury to the skull, such as boxing, rugby or football.
Complications of a brain abscess
Possible complications of a brain abscess are outlined below.
Brain damage
Brain damage can range from mild through moderate to severe.
Mild brain damage can result in:
Headaches
Memory problems
Moderate brain damage can result in:
Changes in mood such as feeling restless or agitated
Problems with tasks that require high-level thinking such as planning and decision making
Difficulties with balance and coordination � the medical term for this is ataxia
Severe brain damage can result in:
Weakness in certain parts of the body
And in the most serious of cases � coma or persistent vegetative state
Mild to moderate brain damage often improves with time. Severe brain damage is likely to be permanent.
Brain damage is more of a risk when the diagnosis of a brain abscess was delayed and treatment did not begin quickly enough. Brain abscesses can now be diagnosed very easily with a CT or MRI scan, so the risk of serious brain damage is now low.
Epilepsy
A common complication of brain abscesses is epilepsy, a condition that causes repeated fits or seizures. Epilepsy is a long-term condition and symptoms can usually be controlled using medication..
Meningitis
In some cases, especially those involving children, a brain abscess can develop into bacterial meningitis, a life-threatening infection of the protective membranes that surround the brain.
Symptoms of meningitis include:
Severe headache
Vomiting
High temperature (fever) of 38�C (100.4�F) or over
Stiff neck
Someone with bacterial meningitis will require urgent treatment in hospital; usually an intensive care unit (ICU).
Antibiotics will be used to treat the underlying infection. These will be given intravenously (through a vein in the arm).
At the same time a person may also be given:
Oxygen
Intravenous fluids (through a vein)
Steroids or other medication to help reduce the inflammation (swelling) around the brain

Atelectasis is the most common post operative pulmonary complication by which tissue oxygenation may be compromised in the elderly. It affects a quarter of all patients recovering from abdominal or thoracic surgeries. . Atelectesis, a failure of part of the lungs to expand, usually develops during the first or second postoperative day. Contributing factors in the aged are shallow breathing, obstruction of the airway with secretions, pain (which results in smaller tidal volumes), immobility, a transient decrease in surfactant production, a weakened cough reflex and decreased ciliary movement. Atelectasis as a result of any of these factors can lead to a mismatching of ventilation and perfusion and thereby, to arterial hypoxemia.
Areas of alveolar collapse or atelectasis are prone to infection. if an area of the lung remains atelectatic for greater than 72 hours, pneumonia is likely to develop. In the elderly, taking agressive measures to prevent atelectasis is preferable to treating pneumonia that may result from it. Frequent incentive spirometry maneuvers with an inspiratory hold, turning every two hourly, early ambulation and mobilization as soon as the vitals are stable, are important therapeutic interventions. Pain management without the use of sedatives, that depresses respirations, can also prevent alveolar compromise.
If atelectasis does develop, strategies such as administration of chest physiotherapy for mobilizing secretion, hyperinflation therapies such as IPPB ( Intermittent positive pressure breathing) or CPAP ( Continuous positive airway pressure) and moderate suctioning may help remove secretion, reverse atelectasis and aid in the reexpansion of lungs.

Now that which we are eating, water which we are drinking, air we are breathing in, all are more or less poisoned. Every day in this way we are become poisonous. Now it is difficult to understand that who is ill and who is healthy. Doctors those who are treating us, also they are not free from poison. Knowingly or unknowingly� day after day gradually we are becoming attacked by severe diseases due to poison. Treatments are becoming impracticable.

So many poisons are there to destroy mankind. Besides deadly insecticides and bacterial poisons (toxins), many more poisons are active to make us poisonous. Influence of many electromagnetic fields and radiations are able to effect poisoning. Daily used utensils, especially cooking utensils are cause of slow poisoning (metal poisoning). Poisoning is being occurred regularly by different kind of chemicals. Food those are genetically modified, create a fatal action of poisoning in our body.

Above all, the mental pollution and mental poisons are making our life more bitter and unbearable. Are you informed about internal secretion of poisons? It occurs due to mental pain, excitement and mental pollution. Except this, intemperance� irregularity is other causes of it.

If there will not happen any sudden accident, the poison will be the cause of destruction of mankind.

What is the test?
In an excisional biopsy of the breast, Dr. B C Shah makes an incision in the skin and removes all or part of the abnormal tissue for examination under a microscope. Unlike needle biopsies, a surgical biopsy leaves a visible scar on the breast and sometimes causes a noticeable change in the breast�s shape. It�s a good idea to discuss the placement and length of the incision with your surgeon beforehand. Also ask Dr. B C Shah about scarring and the possibility of changes to your breast shape and size after healing, as well as the choice between local anesthesia and general anesthesia.
How do I prepare for the test?
You�ll undergo a breast exam and possibly a mammogram before the biopsy to determine where the lump is located. If you are having a sedative with local anesthesia, or if you are having general anesthesia, you�ll be asked not to eat anything after midnight on the day before the surgery
Tell Dr. B C Shah if you�re taking insulin, NSAIDs, or any medicine that can affect blood clotting. You might have to stop or adjust the dose of these medicines before your test.
What happens when the test is performed?
A surgical biopsy is done in an operating room. An IV line is placed in your arm so that you can receive medicines through it. Dr. B C Shah may use local anesthesia with sedation to help you relax during the procedure, or general anesthesia. Surgical biopsies take about an hour, and the recovery period is less than two hours.
An open biopsy that removes only part of a lump of suspicious tissue is called an incisional biopsy; one that removes the entire lump is called an excisional biopsy. An incisional biopsy is usually done when the lump is quite large, since removing a larger lump completely can alter the appearance of the breast. This procedure is appropriate for larger lumps in order to secure a diagnosis while minimizing the effect on the breast�s appearance. If the tissue proves to be cancerous, the remaining portion of the lump will be removed surgically, usually during a second surgical procedure that may be more extensive and involve removal of lymph nodes to determine whether the cancer has spread.
When a breast mass or an area of calcification cannot be felt, Dr. B C Shah may choose to use a procedure called wire localization to help identify the tissue for later surgical biopsy. The first part of this procedure is a mammogram. After applying a local anesthetic, he inserts a hollow needle into the breast and, guided by ultrasound or mammography, places the tip of the needle in the suspicious area. He then inserts a thin wire with a hook on the end through the hollow needle and into the breast alongside the suspicious area. Dr. B C Shah will then removes the needle, leaving the wire in place to serve as a guide to help him find the area of breast tissue to be removed later.
Must I do anything special after the test is over?
Dr. B C Shah will monitor you for a few hours after your surgery to make sure that you�re recovering well and not having any adverse reactions to anesthesia. Contact him if you develop a fever, strong pain at the incision site, or bleeding from the incision. You may need a follow-up visit so that Dr. B C Shah can remove stitches and make sure you are recovering well.
How long is it before the result of the test is known?
A preliminary report from the pathologist might be available when your surgery is over. A final report typically takes three to four days.

By Dr. Rakesh Aggarwal.

Rx:-1. Powder of root of yashtimadhu 3gm TDS water.
2. Gargle of 100ml of warm water with 1/2 gm of saphatika (Alum) many times a day.
3. Gargle of saline water.

Regimen:-1. Avoid smoking.
2. Avoid curd, milk, sour fruits, fried food ect.
3 hot fomentation of neck.