====== Cerebellar abscess ====== {{ ::cerebellarabscess.jpg?300|}} ===== Latest Pubmed Related Articles ===== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1XWEJfKtgOHaBJBnZUX9Sw0fcnYg2BzrV3yexOB7Avo_hLiADW/?limit=15&utm_campaign=pubmed-2&fc=20230116130545}} ---- ---- Collection of [[pus]] (abscess) within the [[cerebellum]]. see also [[Brainstem abscess]]. Cerebellar abscesses are considered a medical emergency and require immediate medical attention. ===== Epidemiology ===== [[Cerebellar abscess epidemiology]] ===== Classification ===== Cerebellar abscesses can be classified based on different aspects, including the etiology, pathogenesis, or clinical presentation. Here are some common classifications used in the context of cerebellar abscesses: Etiology: a. Primary: Primary cerebellar abscesses originate within the cerebellum itself, without any identifiable source of infection outside the central nervous system (CNS). b. Secondary: Secondary cerebellar abscesses arise as a result of an infection that spreads from a nearby site, such as an ear or sinus infection, dental infection, or mastoiditis. Pathogenesis: a. Hematogenous: Hematogenous cerebellar abscesses occur when bacteria or fungi are carried through the bloodstream and reach the cerebellum, typically originating from a distant site of infection. b. Direct extension: Direct extension of infection occurs when an adjacent infected area, such as the mastoid bone or sinuses, spreads the infection to the cerebellum. Clinical Presentation: a. Acute: Acute cerebellar abscesses present with rapid onset of symptoms, such as severe headache, fever, altered mental status, and neurological deficits. b. Chronic: Chronic cerebellar abscesses develop over a longer period and may have a more indolent course, with symptoms that gradually worsen over time. Chronic abscesses can present with a milder headache, vague neurological symptoms, or intermittent fevers. Imaging Characteristics: a. Single abscess: Cerebellar abscesses can be solitary, involving a single well-defined area of infection. b. Multiple abscesses: In some cases, multiple abscesses can develop within the cerebellum, indicating a more extensive infection. It's important to note that the classification of cerebellar abscesses can vary depending on the source or medical literature. The specific classification used may also depend on the context and purpose, such as research, clinical management, or communication among healthcare professionals. Diagnosis and classification of cerebellar abscesses are typically based on a combination of clinical presentation, imaging studies (such as computed tomography or magnetic resonance imaging), microbiological analysis, and patient history. [[Cerebellar tuberculosis]] ===== Etiology ===== In Forty-seven cases of cerebellar [[abscess]], 93% were secondary to [[otogenic]] disease ((Shaw MD, Russell JA. Cerebellar abscess. A review of 47 cases. J Neurol Neurosurg Psychiatry. 1975 May;38(5):429-35. PubMed PMID: 1151412; PubMed Central PMCID: PMC491994. )). Infected intradural dermoid cyst with complete [[dermal sinus]] of [[posterior fossa]] is rare ((Ségbédji FKK, Tokpo AJ, Nubukpo-Guménu AA, Alaoui NK, Quenum LMA, Benzagmout M, Chakour K, Chaoui MF. Infected Intradural Dermoid Cyst with Complete Dermal Sinus of Posterior Fossa. World Neurosurg. 2018 Aug;116:219-224. doi: 10.1016/j.wneu.2018.05.011. Epub 2018 May 16. PubMed PMID: 29753895. )). ===== Clinical features ===== Clinical features are non-specific, with many cases having no convincing [[inflammatory]] or septic [[symptom]]s. Symptoms of raised [[intracranial pressure]], [[seizure]]s, and [[focal neurological deficit]]s are the most common forms of presentation. Eventually, many abscesses rupture into the [[ventricular system]], which results in a sudden and dramatic worsening of the clinical presentation and often heralds a poor outcome. ===== Clinical data ===== Look for: [[Headache]] [[Vomit]]ing [[Comorbidity]]. [[HIV]] ... [[Otogenic abscess]] [[Gait ataxia]] [[Dermoid cyst]] [[Dermal sinus]] [[Hydrocephalus]] [[Microorganism]] [[Antibiotic]]s. [[Glasgow Outcome Scale]] ===== Diagnosis ===== [[Cerebellar abscess diagnosis]]. ===== Differential diagnosis ===== [[Cerebellar hemangioblastoma]] ===== Treatment ===== [[Cerebellar abscess treatment]] ===== Case series ===== [[Cerebellar abscess case series]] ===== Case reports ===== see [[Cerebellar abscess case reports]]. ===== Case from the HGUA ===== A 55-year-old man attended the emergency department due to [[holocranial]] [[headache]] and [[neck pain]] accompanied by rotational [[dizziness]], impossibility to walking with deviation to the right, and continuous [[nausea]] for 24 hours. He refers to having been on antibiotic treatment for suppurative [[otitis media]] in the last 15 days. No [[fever]]. After performing a cranial CT, he was transferred to our center for neurosurgical evaluation {{::q3361.jpg?200|}} A [[hypodense]] [[area]] with an [[air fluid level]] within it of approximately 4.4 cm x 3.6 cm is visualized, in the left [[cerebellar hemisphere]], which enhances after IV [[contrast]] and causes a [[mass effect]] on the [[fourth ventricle]] and an increase in the ventricular size of the lateral [[horn]]s, in relation to [[cerebellar abscess]] with secondary [[hydrocephalus]]. Content is visualized inside the left [[mastoid]]. Hypodense foci in subcortical [[white matter]], predominantly bilateral frontoparietal, in [[semioval center]]s, [[corona radiata]], and periventricular, nonspecific, which could be related to small vessel ischemia, being very numerous for the patient's age. Hypodense foci in the left [[external capsule]] suggest Virchow-Robin spaces vs. chronic [[lacunar infarct]]ion. Findings in relation to an [[abscess]] in the left cerebellar hemisphere that causes [[hydrocephalus]], especially of the [[lateral ventricle]]s. ---- After evacuation by retrosigmoid craniotomy, 1 month after reoperation due to recurrence.