What is Cerebral Abscess?
On rare occasions an infection may set up in a localised fashion in the brain substance. It never occurs as a primary infection, but is always secondary to spread of infection from some other site. This may be by direct spread from other parts of the head or neck, such as infected sinuses, infections about the eye orbit, boils or carbuncles (perhaps around the neck), or infected ears. The germ is commonly any of the widely occurring types, such as the streptococcus, pneumococcus and staphylococcus. About 70 per cent of brain abscesses are produced in this manner.
About 20 per cent arise from infections in more distant areas such as more resistant organisms developed. In due course, this will produce a rise in the incidence of neurosyphilis. Although all stages may overlap, there are three main forms of neurosyphilis: (1) General paralysis of the insane; (2) tabes dorsalis, and (3) meningovascular syphilis.
These three will be dealt with briefly.
General Paralysis of the Insane (GPI or Dementia Paralytics)
This usually occurs in males, commonly eight to 20 years after infection with the syphilis germ. Symptoms are more common in the 30-50-years age segment. This is now a rare disease, and some major hospitals have not reported a single admission in the past several years.
Symptoms
The chief symptom is mental impairment. This may be preceded by a reduction of emotional control.
Lack of concentration follows and persists. The patient loses interest in all activities and hobbies, showing deficiency of judgment, is forgetful, inattentive and careless. In cases of lesser magnitude, the chief impairment may be a general loss of interest in normal activities and pursuits.
Due to penicillin curing the underlying disease, the full-blown case of GPI is now rarely seen. General weakness and, finally, various stages of paralysis were part of the general downhill course taken by the patient.
Penicillin has completely changed the picture of the GPI patient, and intensive therapy can totally cure the infection. In due course, the patient often shows signs of recovery, but this may be dependent on the degree of nerve-cell destruction. However, even those with considerable nerve destruction can still gain a great deal of improvement.
Naturally, symptoms suggesting this form of infection (and there is always the history of infection years before) need expert medical attention. There is no place for home treatments, but diagnosis and therapy are in the province of the doctor.
Tabes Dorsalis
This is another form of neural syphilitic involvement. Symptoms are wide-ranging, due to destruction of the posterior columns of the spinal cord. This produces disturbances of walking and a host of nervous symptoms.
Once more, this is now rarely seen, so only a brief description will be given.
Symptoms
Lightning pains are characteristic, consisting of sudden, stabbing pains often in the shins and lower parts of the legs, on the nose, in the chest and forearm. The reflex actions of the joints are reduced and the muscles tend to become limp and flabby. A symptom called ataxia takes place, in which the patient loses the sense of appreciation of space. This often results in a strange way of walking called ataxia.
Impotence is usual, and there is difficulty in starting the urinary stream, plus incontinence at night. The pupils, normally of equal size, become irregular in outline. The eyelids tend to droop (ptosis), the face becomes puffy, and vision deteriorates, sometimes markedly. The typical tabes facies (appearance of the face) develops. Sometimes bouts of intractable vomiting lasting for days may result. The joints, particularly the knee, hip, ankle, and later the small joints of the hands and feet may become involved and show marked derangement, swelling and pain. Sometimes large, virtually painless ulcers (especially of the feet) develop.
The disease may be completely arrested by large doses of penicillin, still the treatment of choice and often given in combination with other medication. Any medical care must be under expert professional supervision, if the patient is to gain relief from symptoms.
Meningovascular Syphilis
As with other forms of syphilis, this is now also quite rare, and accounts for very few hospital admissions. Symptoms may come on one to five years after infection, or as long as 30 – 40 years later. Usually the patients are young men.
Symptoms occur as a result of the germ affecting the meninges (the brain linings) and the blood vessels of the brain substance itself.
Symptoms
These will vary according to the areas chiefly affected and the extent of the damage. However, symptoms may include headaches, lethargy and impairment of intellect. Memory may be adversely affected. The cranial nerves may be involved, producing various forms of facial palsy, and changes in the pupils and the eye movements.
Cerebral Abscess Treatment
Treatment is by large doses of penicillin, which will arrest the progression of the disease. Recovery is the rule, but some varying extent of mental impairment may result and persist.
Today we are seeing a modern-day version of what syphilis was in the last century and early part of the 20th century. The sudden explosion of the AIDS epidemic is similar in many respects. It is sexually transmitted in most cases, is preventable by simple attention to lifestyle habits and has no known cure. For many years (until the advent of penicillin) there was no really satisfactory treatment for syphilis.
However, just as syphilis was rampant because people refused to change habits and lifestyle, so for identical reasons it is similarly unlikely that AIDS will suddenly stop. If people bothered to consider the involvements of their own foolish indiscretions and acted accordingly, much trouble would automatically be removed from the world.