Cerebral abscess (summary)

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Cerebral abscesses represent focal areas of infection within brain parenchyma, usually containing pus and having a thick capsule. They typically have enhancing walls and can mimic a number of other significant pathologies.

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This is a summary article; read more in our article on cerebral abscess.

Summary

epidemiology
- may occur at any age
- risk factors
  - ~~systemic infection~~immunocompromise (including HIV, diabetes mellitus)
  - ~~remote abscess~~existing infection (eg. middle ear infection, bacteraemia)
  - IV drug ~~abuse~~use
presentation
- ~~neurological symptoms rather than signs of infection~~fever, headache, and focal neurology may be present
- signs of raised ICP, focal neurology or seizures should prompt imaging
pathophysiology
- spread of infection to the brain
  - inflammation and irritation of parenchyma
    - thin walled abscess formation
- source
  - haematogenous spread is the commonest route ¹
    - infection crosses the blood-brain barrier
  - direct infection may occur
    - mastoiditis or sinusitis
    - requires a severe infection and bone destruction
- microbiology
  - mixed bacteriology
  - sterile cultures in 25-34% of cases ^1,2
  - gram negative bacteria commoner in paediatrics and immunocompromised patients
  - fungal infection commoner in the immunocompromised
investigation
- blood work to include inflammatory markers and renal function
- cross-sectional imaging
  - CT with contrast - first line
  - MRI (diffusion-weighted imaging is important)
role of imaging
- initial diagnosis
- assessment of any mass-effect, e.g. from surrounding oedema
- assessment of any other lesions
- aid surgical planning
radiographic features
- CT
  - first line imaging
  - low-density lesion with peripheral enhancement
  - surrounding low-density white-matter oedema
- MRI
  - more sensitive
  - pus is bright on T2 weighted images
  - the wall of the abscess typically lights up after contrasts
  - diffusion restriction within the abscess cavity is helpful to make the diagnosis
treatment
- usually require operative management
- ~~intensive~~aggresive IV antibiotic therapy ¹

~~-<li>systemic infection</li>~~
~~-<li>remote abscess</li>~~
~~-<li>IV drug abuse</li>~~
+<li>immunocompromise (including HIV, diabetes mellitus)</li>
+<li>existing infection (eg. middle ear infection, bacteraemia)</li>
+<li>IV drug use</li>
~~-<li>neurological symptoms rather than signs of infection</li>~~
+<li>fever, headache, and focal neurology may be present</li>
~~-<li>intensive IV antibiotic therapy <sup>1</sup>~~
+<li>aggresive IV antibiotic therapy <sup>1</sup>

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Cerebral abscess (summary)

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