28th July 2023

Cerebral abscesses

Abscesses in the brain generally arise secondary to infections, such as otitis media, mastoiditis or sinus infection. They may also result from facial or head trauma, including surgery and implantation of foreign bodies, or due to trauma. The most common causative organisms are Staphylococcus and Streptococci species.

Cerebral abscesses generally present predominantly with a severe headache and often have a subacute presentation of 1-2 weeks. Fever, confusion, drowsiness, focal neurological deficits and seizures may also be seen. There may be localised pain at the site of the abscess.

Imaging findings vary depending on the stage of the disease. The characteristic finding is a ring-enhancing solitary lesion on CT. MRI is more accurate and can be used to further characterise the lesion following CT.

A brain abscess is a medical emergency. The risk of raised intracranial pressures necessitates urgent neurosurgical referral. Antibiotic treatment is similar to the approach taken in meningitis and should be tailored as per sensitivities whenever possible.