Cerebral abscess (summary)

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.

Reference article

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

Summary

  • epidemiology
    • may occur at any age
    • risk factors
      • systemic infection
      • remote abscess
      • IV drug abuse
  • presentation
    • neurological symptoms rather than signs of infection
    • 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 IV antibiotic therapy 1
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Article information

rID: 34339
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Cases and figures

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    Case 1: non-contrast CT with hyperdense rim with surrounding oedema
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    Case 1: contrast showing ring-enhancing lesion
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    Case 2: T2 MRI images with high signal (consistent with fluid)
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    Case 3: left sided abscess with contrast enhancement
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    Case 4: fungal abscesses
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