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Abscess on the Brain
Aug 3, 1996

A friend has been diagnosed as having AIDS. She became very ill at the beginning of January. I was told by her family that she had an abcess onher brain. She suffered what seemed to me to be a stroke, and could not remember anyone. Could you tell me what it means to have an abcess on the brain and is it treatable.

Response from Dr. Cohen

An abscess is a general term for a collection of infected material. When you have an abscess on the skin, it is called a boil, and it contains "pus"-- fluid composed of white cells and bacteria.

You can get those kind of bacterial abscesses in the brain, also. The bacteria may get to the brain from the bloodstream (especially in people who use intravenous drugs) or from an extension of infection elswewhere (especially the sinuses). However, in AIDS patients abscesses in the brain are more commonly caused by opportunistic organisms. The most common cause of a brain abscess in AIDS patients is the parasite toxoplasma, which causes toxoplasmosis, or toxoplasmic encephalitis. There are other causes-- tuberculosis, cryptococcus, nocardia-- but they are much less common.

All of the infections I have mentioned are treatable, although there may be brain damage that cannot be reversed. The usual approach is to treat for the most common problem-- toxoplasmosis. If things get better over 10 to 14 days, then that is the diagnosis. If they don't get better, then a brain biopsy may be necessary to determine whether the lesion is caused by another kind of infection, or by lymphoma or PML.

These are general comments-- I can't tell you what kind of abscess you friend has, or whether it is treatable.



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