Brain abscess

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Background

  • 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
    • Streptococci in 50% of cases[1]
    • Anaerobes and Gram-negative rods are typical pathogens
    • Staph is involved with direct implantation cases

Clinical Features

  • Patients rarely appear acutely ill
  • Classic traid of headache, fever, AND focal neuro deficit is present in <33%
    • Headache is most common symptom (present in almost all cases)
    • Fever (~50% of patients)
  • Focal neuro symptoms or seizure (~33% of patients)
  • Neck stiffness (<50% of patients)
  • Signs of increased ICP: papilledema, vomiting, confusion, obtundation (50% of patients)

Differential Diagnosis

Intracranial Mass

Evaluation

Workup

Evaluation

  • 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

Management

Antibiotics

Otogenic source

Sinogenic or odontogenic source

Penetrating trauma or neurosurgical procedures

Hematogenous source

No obvious source

Disposition

  • Neurosurgery consultation

References

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