Brain abscess

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Lobes of the brain.
  • Caused by one of three methods:
    • Hematogenous spread (33%)
    • Contiguous infection from middle ear, sinus, teeth (33%)
    • Direct implantation by surgery or penetrating trauma (10%)
  • Microbiology

Clinical Features

Differential Diagnosis

Intracranial Mass

Altered mental status and fever


Brain abscess on CT (arrows) with left hemiplegia.
Nocardia brain abscess on MRI. (A) T1-WI shows rim-enhancing lesion with associated edema in the right occipital lobe. (B) The dark signal on T2-WI and consistent thickness of the wall suggest a brain abscess.
  • Head CT with contrast
    • Ring enhancing lesion surrounding low-density center surrounded by white matter edema
    • Early in course ring may be less defined; CT may only show area of focal hypodensity
  • Blood cultures
  • Consider additional workup to evaluate for alternate etiologies/complications of underlying disease process



Otogenic source

Sinogenic or odontogenic source

Penetrating trauma or neurosurgical procedures

Hematogenous source

No obvious source


  • Neurosurgery consultation


  1. Somand D, Meurer W. Central Nervous System Infections. EMCNA 2009; 27: 89-100.