Introduction

Brain abscesses may result from a number of causes including, extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis

Epidemiology

  • Incidence: 0.80 cases per 100,000 person-years
  • Peak incidence: 20-30 years
  • Sex ratio: more common in males 2:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

The presenting symptoms will depend upon the site of the abscess (those in critical areas e.g. motor cortex) will present earlier. Abscesses have a considerable mass effect in the brain and raised intracranial pressure is common.
  • headache
    • often dull, persistent
  • fever
    • may be absent and usually not the swinging pyrexia seen with abscesses at other sites
  • focal neurology
    • e.g. oculomotor nerve palsy or abducens nerve palsy secondary to raised intracranial pressure
  • other features consistent with raised intracranial pressure

Investigations

Investigations
  • Assessment of the patient includes imaging with CT scanning

Management

Management
  • surgery
    • a craniotomy is performed and the abscess cavity debrided
    • the abscess may reform because the head is closed following abscess drainage.
  • IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
  • intracranial pressure management: e.g. dexamethasone