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- Purulent collection within the brain most commonly arising from hematogenous sources of infection (pulmonary, cardiac, renal). Contiguous spread (sinusitis, dental, and mastoiditis) or direct trauma (postoperative, gunshot) are also sources of infection.
- Symptoms can mimic brain tumors but can progress rapidly (days to weeks)—mean duration of symptoms around 8.3 days.
- Treatment includes IV antibiotics, needle drainage, and/or surgical excision.
- Synonym(s): cerebral abscess
Age does not affect outcome as much as the abscess size and state of neurologic dysfunction at presentation.
- ~1/3 of total cases occur in the pediatric age group.
- Newborns or infants may present with cranial enlargement.
- Frequently associated with cyanotic congenital heart disease (risk of abscess 4–7%)
- Predominant age: median age 30 to 40 years, although brain abscess occurs at all ages
- Predominant sex: male > female (2:1)
Reported range from 0.3 to 1.3 per 100,000; however, rates are increased in immunocompromised patients and in developing countries; approximately 2,000 cases a year in the United States
Etiology and Pathophysiology
- Abscess formation can result from contiguous spread, hematogenous spread, or direct trauma.
- Direct extension from otitis, mastoiditis, sinusitis, or dental infection
- Bacteremia from lung abscess, pneumonia, endocarditis
- Fungal infection of the nasopharynx
- Common locations are frontal and temporal lobes.
- Contiguous spread from odontogenic and sinus infections frequently present with frontal lobe abscesses.
- Contiguous spread from mastoiditis typically present with temporal lobe or cerebellar abscesses, although widespread use of antibiotics for otitis have decreased the incidence this presentation.
- Four stages include early and late cerebritis followed by early and late capsule formation (1); most common organisms: streptococci, staphylococci (especially after neurosurgery), enteric gram-negative bacilli, anaerobes (usually same as source of infection), Nocardia, fungi, or polymicrobial
- Toxoplasma gondii (HIV/AIDS patients)
- Most common fungal sources include Aspergillus sp., Candida sp., and Zygomycetes.
- Risk factors for fungal infection include immunocompromised, penetrating CNS trauma, and immunocompetent hosts in fungal endemic areas.
- Amebic brain abscess, amebiasis, amebic dysentery
No known genetic pattern
- Immunocompromised state (e.g., organ transplantation)
- IV drug abuse
- Penetrating skull trauma
- Prior craniotomy
- Cyanotic congenital heart disease
- Treat potential sources of infection: otitis media, mastoiditis, sinusitis, dental abscess, other ear/nose/throat (ENT) infections.
- Prophylactic antibiotics after compound skull fracture or penetrating head wounds
Commonly Associated Conditions
- Congenital heart disease
- Cardiac vegetations
- Organ transplantation (solid organ and hematopoietic stem cell)