Brain abscess

Question 1

Causes

Answer 1

A space-occupying intracerebral lesion of focal infection from local spread or bloodstream.

Usually polymicrobial organisms.

In immunosuppressed, consider:

• Toxoplasma
• Nocardia sp.
• fungi.

Question 2

Clinical features

Answer 2

Raised intracranial pressure

Headache

Nausea and vomiting

Altered conscious state

Papilloedema

Other

• Focal neurological signs such as hemiplegia, dysphasia, ataxia
• Seizures (30%)
• Fever (may be absent)
• Signs of sepsis elsewhere: e.g. teeth, endocarditis

Question 3

Investigations

Answer 3

MRI (if available) or CT scan

• FBE
• ESR/CRP
• blood culture

Lumbar puncture is contraindicated.

Consider endocarditis

Management is urgent neurosurgical referral.