1. Brain Abscess & Intracranial Tumors
By Sarah Hofman

2. What is a brain abscess, you ask?
Brain abscess is an accumulation of pus within the brain tissue that can result from a local or a systemic infection.

3. This image is an CT scan of a brain abscess.

4. CAUSES ** other causes for brain abscess formation include:
*septic venous thrombosis from a pulmonary infection,
*infective endocarditis
*skull fracture
* Nonsterile neurological procedure.
** Direct extension from from ear, tooth, mastoid, or sinus infection is the primary cause.
** streptococci and staphylococci are the primary organism.

5. Clinical manifestations
Are similar to those of meningitis and encephalitis and include headache and fever.
Signs of ICP may include drowsiness, confusion, and seizures.
Focal symptoms may be present and reflect the local area of the abscess.

6. The treatments of choice
Antimicrobial therapy is the primary treatment for brain abscess.
Other manifestation are treated symptomatically.
If drug therapy is not effective, the abscess may need to be removed if it is encapsulated.

7. A few statistics In untreated cases the mortality rate approaches 100%
Seizures occur in approximately 30 % of cases

8. Nursing interventions
Nursing interventions are similar to those for management of meningitis or increased ICP.
If surgical removal is the treatment of choice, nursing interventions are similar to those described under intracranial tumors.

9. Now on to intracranial
tumors

10. Intracranial Tumors

11. What its all about….
Intracranial tumors include both benign and metastatic lesions
All areas and structures of the brain can be affected.
Primary intracranial tumors, or neoplasms, arise from the cells of brain tissue and the primary and pineal glands.
These tumors include gliomas, mengiomas, pituitary tumors, and neuromas.
Metastatic tumors also occur frequently in yhe brain
Brain tumors are named for the tissues from which they arise.

12. subjective data
Patients understanding of the diagnosis
Changes in personality
Presence of abnormal sensations or visual problems.
Complaints of unusual odors may be present with tumors of the temporal lobe
objective data
Motor strength s, gait, the level of alertness and consciousness, and orientation.
The pupils are assessed for response and equality.
The presence of seizures in an adult is significant.
Speech abnormalities, and signs of ICP.

13. diagnostics
No one procedure is entirely diagnostic of brain tumors, but a CT scan is often the basis for the diagnosis.
Other tests that may be performed include the brain scan, MRI, PET scan, and the EEG.

14. Medical management
The general method of treatment for intracranial tumors includes surgical removal when feasible, radiation, and chemotherapy.
The choice of therapy is determined by the tumor type and site
A combination of methods is often used.
This image shows the effect of chemotherapy on the brain tumor

15. Surgical management
Craniotomy- after removal of the bone, an incision is made into the meninges and the tumor is removed.
The removed bone is carefully reserved and may be replaced at the end of the surgery if there is no indication of infection or increased ICP.
Craniectomy
Recent advances have been made in the use of intracranial endoscopy.

16. Nursing interventions
Preoperative
Preparation of patient and the family
Base line neurological assessment
Explaining treatment and procedures (eg. shaving of hair)
Hair is shaved in operating room and may be saved for pt to make wig.
Family needs to be prepared for the appearance of the pt after surgery
Postoperative
Care is determined by the pt’s condition.
Most pts spend one or two nights in ICU under close nursing observation with frequent neurological checks
Assess carefully for indications of increased ICP
Monitor pts residual motor and sensory problems as a result of the tumor or surgery.

17. The out look……
The out look for the patient with a brain tumor depends on whether the tumor is benign or malignant and on the size and location of the mass. Tumors that infiltrate the brain usually results in a decreased life span. With radiation and chemotherapy, patients with a malignant tumors my be assisted in living longer.