Cerebral abscess

Alternative names:

abscess - brain; brain abscess; CNS abscess

Treatment:

Cerebral abscess is a medical emergency! Intracranial pressure may become high enough to cause fatal brainstem herniation. Hospitalization is required until the condition is stabilized.

Life support (such as breathing and circulation assistance) may be required in some cases.

Medical management is advised for multiple abscesses, a small (less than 2 cm) abscess, an abscess deep within the brain, an abscess accompanied by meningitis, the presence of shunts in the brain (for hydrocephalus), or an underlying disease that makes surgery dangerous (debilitating disease).

Antimicrobials are given, initially through a vein, then by mouth. Between 2 and 6 weeks of medication are usually required. Broad-spectrum antibiotics are the most common antimicrobial prescribed. Multiple medications may be used together. Antifungal medications (or antiviral medications) may also be prescribed if fungal or viral infection is likely.

Osmotic diuretics such as urea or mannitol are used to reduce swelling of the brain. Corticosteroids such as dexamethasone also might be used to reduce brain swelling, but their use is more controversial.

Surgery is indicated if there is persistent or progressive increase in intracranial pressure, if the mass does not reduce after use of antimicrobial medications, or if the mass contains gas (produced by some types of bacteria). It may also be needed if there are signs of impending rupture of the abscess into the ventricle.

Surgery consists of opening and draining the abscess and is usually accompanied by cultures of the fluid. This allows antimicrobial treatment to be adjusted so that it is specific to the causative microorganism. The specific surgical procedure depends on the size and depth of the mass. The entire mass may be removed (excised) if it is near the surface and completely encapsulated. A CT scan-guided needle aspiration may be needed for deep abscess; this may also include injecting antimicrobials directly into the mass.

Expectations (prognosis):

If untreated, the disorder is uniformly fatal. The outcome is usually improved with the use of CT scans for accurate diagnosis and administration of broad-spectrum antimicrobials.

Death rate is around 10% with treatment. Neurologic changes may be chronic. Seizures or neurologic losses may occur after surgery. Infection may spread and cause severe life-threatening meningitis.

Complications:

• meningitis, severe and life threatening
• epilepsy
• permanent neurologic losses (vision, speech, movement)
• recurrence of infection

Calling your health care provider:

Go to the emergency room or call the local emergency number (such as 911) if symptoms occur. Cerebral abscess is a medical emergency!