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Brain Abscess

Brain Abscess is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • 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

Geriatric Considerations
Age does not affect outcome as much as the abscess size and state of neurologic dysfunction at presentation.

Pediatric Considerations
  • ~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%)

Epidemiology

  • Predominant age: median age 30 to 40 years, although brain abscess occurs at all ages
  • Predominant sex: male > female (2:1)

Incidence
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

Genetics
No known genetic pattern

Risk Factors

  • HIV/AIDS
  • Immunocompromised state (e.g., organ transplantation)
  • IV drug abuse
  • Penetrating skull trauma
  • Prior craniotomy
  • Cyanotic congenital heart disease

General Prevention

  • 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

  • AIDS
  • Congenital heart disease
  • Cardiac vegetations
  • Diabetes
  • Cirrhosis
  • Organ transplantation (solid organ and hematopoietic stem cell)

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Citation

Stephens, Mark B., et al., editors. "Brain Abscess." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816276/all/Brain_Abscess.
Brain Abscess. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816276/all/Brain_Abscess. Accessed April 18, 2019.
Brain Abscess. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816276/all/Brain_Abscess
Brain Abscess [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816276/all/Brain_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Brain Abscess ID - 816276 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816276/all/Brain_Abscess PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -