Neuropathological and computerized tomographic findings in experimental brain abscess

Abstract

The neuropathological progression of brain abscess formation was studied experimentally at sequential stages in dogs, and the findings correlated with the appearance on computerized tomographic (CT) brain scans. The evolution of brain-abscess formation was divided into four stages based on histological criteria: early cerebritis (Days 1 to 3); late cerebritis (Days 4 to 9); early capsule (Days 10 to 13); and late capsule (Days 14 and later). The cerebritis stage was characterized by prominent perivascular cuffing by inflammatory cells in the area adjacent to the developing necrotic center. However, the early elements of capsule formation appeared with the presence of fibroblasts by Day 5. The CT scans showed ring-shaped contrast enhancement by Day 3. Delayed scans at 30 minutes revealed diffusion of the contrast material into the developing necrotic center, forming a solid lesion. In lesions that were well encapsulated (14 days and older), five distinct histological zones were apparent: 1) a well formed necrotic center; 2) a peripheral zone of inflammatory cells, macrophages, and fibroblasts; 3) the dense collagenous capsule; 4) a layer of neovascularity associated with continuing cerebritis; and 5) reactive astrocytes, gliosis, and cerebral edema external to the capsule. The CT appearance of well encapsulated abscesses showed a typical ring-shaped contrast-enhancing lesion. On the delayed scans, the "ring" did not fill in with contrast enhancement. The diameter of the ring correlated best with the presence of cerebritis (perivascular infiltrates in the adventitial sheaths of vessels surrounding the abscess). The discussion focuses on the relevance of this study to the current management of patients with brain abscess.

Toxic levels of ammonia in human brain abscess

“…A brain abscess is surrounded by a capsule composed of reactive astrocytes and fibrous tissue. 3 The capsule is not a diffusion barrier, however, 25,39 so ammonia would be able to diffuse from the abscess cavity into the surrounding brain tissue. Here, ammonia may contribute to edema formation 14,33,35 and interfere with neurotransmission and astrocytic potassium handling, as is illustrated in hyperammonemic states.…”

Evaluation of different cerebral mass lesions by perfusion‐weighted MR imaging

“…In the literature there are few studies about PWI findings of abscess (24,47). In the experimental setting, brain abscesses have been shown to have relatively high amounts of mature collagen and decreased neovascularity (48). On a theoretical basis, such histologic features should be associated with low capillary density and rCBV, which may serve explain the lower rCBV ratios found in abscesses (47).…”

In Vivo Differentiation of Aerobic Brain Abscesses and Necrotic Glioblastomas Multiforme Using Proton MR Spectroscopic Imaging

“…In the experimental setting, brain abscesses have been shown to have relatively high amounts of mature collagen and decreased neovascularity. 27,28 The Cho/Cr ratio of rim-enhancing lesion of abscesses would be presumed to be less than that of GBMs.…”