Table of contents
Brain abscess
What's new
Added 2023 ESCMID guidelines for the diagnosis and management of brain abscess.
Background
Overview
Definition
Brain abscess is a focal infection within the brain parenchyma, characterized by a localized area of cerebritis that eventually transforms into a collection of pus within a well-vascularized capsule.
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Pathophysiology
The pathophysiology of a brain abscess typically involves bacterial infection, which can arise from contiguous sites such as the sinuses, middle ear, or mastoid or through hematogenous spread from a distant site. Common causative pathogens include Bacteroides species, K. pneumoniae, Viridans streptococci, and S. aureus.
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Epidemiology
The incidence of brain abscess is estimated at 0.4-0.9 per 100,000 person-years.
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Risk factors
Risk factors for brain abscess include immunocompromised status, chronic sinusitis, and a history of head trauma. Other factors such as old age, black race, ear infection or mastoiditis, and pre-existing conditions like hemiplegia and high comorbidity burden have also been associated with increased risk.
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Disease course
Clinically, patients with a brain abscess may present with headache, fever, neurological deficits, altered mental status, and signs of increased ICP. The clinical presentation can vary depending on the location and size of the abscess and the patient's immune status.
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Prognosis and risk of recurrence
The prognosis of brain abscess has improved over time due to advancements in neurosurgical techniques, cranial imaging, and antimicrobial regimens.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of brain abscess are prepared by our editorial team based on guidelines from the European Society for Microbiology and Infectious Diseases (ESCMID 2024), the American Heart Association (AHA 2015), and the Infectious Diseases Society of America (IDSA 2011).
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Diagnostic investigations
Brain imaging
As per ESCMID 2024 guidelines:
Obtain brain MRI, including DWI/apparent diffusion coefficient and T1-weighted imaging, with and without gadolinium in patients with suspected brain abscess.
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Obtain contrast-enhanced CT if MRI is not available.
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Laboratory tests
Medical management
Antimicrobial therapy, timing: as per ESCMID 2024 guidelines, consider withholding antimicrobials until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be performed within a reasonable time, preferably within 24 hours of radiological diagnosis.
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Antimicrobial therapy (choice of regimen)
Antimicrobial therapy (duration)
Antimicrobial therapy (consolidation)
Corticosteroids
Seizure prophylaxis