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Neurosurgery is not primarily concerned with infectious diseases of the brain and its cases. Targeted antimicrobial treatment falls within the competence of neurology and infectious medicine. Surgery is only suitable in the case that a pus deposit has formed intracranially. Typically this pus is between the brain and dura mater (subdural empyema), or abscesses in the brain tissue.
Symptoms of infection derive from their general nature (fever, fatigue, general exhaustion – as for any other infectious disease) and from their intracranial location (headache, blurred vision, impaired speech, movement disorders of the limbs or any other neurological deficit). Epileptic fits can also be a symptom.
Diagnosis of empyema and abscess indirectly relies on general blood test signs of inflammation, although the main diagnostic method is graphic display. The basic technique is computed tomography (CT) with contrast medium administration into the patient’s vein. Magnetic resonance (MRI) provides more precise information on the deposit, which is especially necessary for brain abcesses. By using MR spectroscopy, abcesses can be distinguished from similar looking findings, in particular brain tumours, with a reasonable degree of reliability. Imaging methods are also a source for neuronavigation during operations, enabling the surgeon to take the shortest and least risky path to the collection of pus in the brain.
The actual surgical treatment of purulent deposits is only the first step. After determining the nature of the pathogen, a course of strong antibiotics follows, lasting several months. These are administered intravenously during the patient’s hospitalization for the first 2-6 weeks. Total screening and searching for the original cause of the onset of this serious and life-threatening
