Cerebral abscess (summary)

Last revised by Sally Ayesa on 6 Sep 2022

Citation, DOI, disclosures and article data

Citation:

Smith D, Ayesa S, Hacking C, et al. Cerebral abscess (summary). Reference article, Radiopaedia.org (Accessed on 23 Apr 2024) https://doi.org/10.53347/rID-34339

DOI:

https://doi.org/10.53347/rID-34339

Permalink:

https://radiopaedia.org/articles/34339

rID:

34339

Article created:

16 Feb 2015, Derek Smith ◉

Disclosures:

At the time the article was created Derek Smith had no recorded disclosures.

View Derek Smith's current disclosures

Last revised:

6 Sep 2022, Sally Ayesa ◉

Disclosures:

At the time the article was last revised Sally Ayesa had no financial relationships to ineligible companies to disclose.

View Sally Ayesa's current disclosures

Revisions:

17 times, by 8 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Tags:

neuro, cns, infection, abscess, medical student, teaching, summary

This is a basic article for medical students and other non-radiologists

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.

epidemiology
- may occur at any age
- risk factors
  - immunocompromise (including HIV, diabetes mellitus)
  - existing infection (eg. middle ear infection, bacteremia)
  - IVDU
presentation
- 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
  - hematogenous 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 pediatrics 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)
treatment
- usually require operative management
- aggresive IV antibiotic therapy ¹

Imaging

role of imaging
- initial diagnosis
- assessment of any mass-effect, e.g. from surrounding edema
- 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 edema
- MRI
  - more sensitive
  - pus is bright on T2 weighted images
  - the wall of the abscess typically enhances post contrast
  - diffusion restriction within the abscess cavity is helpful to make the diagnosis

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