Liquefactive necrosis

Liquefactive necrosis: Description, Causes and Risk Factors: A type of necrosis characterized by a fairly well-circumscribed, microscopically or macroscopically visible lesion that consists of the dull, opaque or turbid, gray-white to yellow-gray, soft or boggy, partly or completely fluid remains of tissue that became necrotic and was digested by enzymes, especially proteolytic enzymes liberated from disintegrating leukocytes; it is classically observed in abscesses, and frequently in infarcts of the brain.liquefactive necrosis MedigooLiquefactive necrosis is typically seen in the brain. Because neurones have a much higher lysosomal content, autolysis dominates, leading to liquefaction. Macroscopically, necrotic brain tissue is therefore soft and semisolid. Liquefactive necrosis may also be seen in other organs following severe bacterial infections due to massive outpouring of enzymes from neutrophils destroying the tissue.Liquefactive necrosis is a type of necrosis which results in a transformation of the tissue into a liquid viscous mass. Often it is associated with focal bacterial or fungal infections. In liquefactive necrosis, the affected cell is completely digested by hydrolytic enzymes, resulting in a soft, circumscribed lesion consisting of pus and the fluid remains of necrotic tissue. Dead leukocytes will remain as a creamy yellow pus. After the removal of cell debris by white blood cells, a fluid filled space is left. It is generally associated with abscess formation and is commonly found in the central nervous system (CNS).Liquefactive necrosis develops when enzymatic digestion is the dominant pattern. It is due to the destructive effects of lytic enzymes generated by neutrophils and macrophages in infected tissues. The ultimate result of proteolytic digestion is liquefaction of necrotic tissue. A bacterial abscess filled with collections of fluid pus is an example of liquefactive necrosis. Bacterial infection is the principal cause of liquefactive necrosis but not the only one. For obscure reasons, ischemic injury within the central nervous system after arterial occlusion evokes liquefactive necrosis. The dead brain tissue is softened and converted into a liquid viscous mass. As time passes, there develops a cystic space filled with clear fluid, the walls of which are defined by non-necrotic tissue.

Liquefactive necrosis Symptoms:

1. Changes in mental status
  • Confusion.
  • Decreasing responsiveness.
  • Drowsiness.
  • Eventual coma.
  • Inattention.
  • Irritability.
  • Slow thought processes.
2. Decreased movement. 3. Decreased sensation. 4. Decreased speech (aphasia). 5. Fever and chills. 6. Headache. 7. Language difficulties. 8. Loss of coordination. 9. Loss of muscle function. 10. Seizures. 11. Stiff neck 12. Vision changes

Signs:

The affected area is soft with liquefied centre containing necrotic debris. Later, a cyst wall is formed. Microscopically, the cystic space contains necrotic cell debris and macrophages filled with phagocytosed material. The cyst wall is formed by proliferating capillaries, inflammatory cells, and gliosis (proliferating glial cells) in the case of brain and proliferating fibroblasts in the case of abscess cavity.

Diagnosis:

A brain and nervous system (neurological) exam will usually show increased intracranial pressure and problems with brain function. Tests to diagnose a liquefactive necrosis may include:
  • Head CT scan.
  • Electroencephalogram (EEG).
  • MRI of head.
  • Blood cultures.
  • Complete blood count (CBC).
  • Testing for the presence of antibodies to organisms such as Toxoplasma gondii and Taenia solium.
A needle biopsy is usually performed to identify the cause of the infection.

Treatment:

Treatment of liquefactive necrosis typically involves two distinct processes. Usually, the underlying cause of the necrosis must be treated before the dead tissue itself can be dealt with. Even after the initial cause of the necrosis has been halted, the necrotic tissue will remain in the body. The body's immune response to apoptosis, the automatic breaking down and recycling of the cell material, is not triggered by necrotic cell death. Antibiotics will be prescribed. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are most commonly used. You may be prescribed several different types of antibiotics to make sure treatment works. Antifungal medications may also be prescribed if the infection is likely caused by a fungus. The standard therapy of liquefactive necrosis is surgical removal of necrotic tissue. Depending on the severity of the necrosis, this may range from removal of small patches of skin, to complete amputation of affected limbs or organs. Chemical removal, via an enzymatic debriding agent, is another option. In select cases, special maggot therapy has been utilized with good results. NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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