Brain abscess

Question 1

Causes?

Answer 1

Brain abscesses may result from a number of causes including, extension of sepsis from middle ear or sinuses, trauma or surgery to the scalp, penetrating head injuries and embolic events from endocarditis

Question 2

presenting symptoms

Answer 2

The presenting symptoms will depend upon the site of the abscess (those in critical areas e.g. motor cortex) will present earlier. Abscesses have a considerable mass effect in the brain and raised intracranial pressure is common.
headache
often dull, persistent
fever
may be absent and usually not the swinging pyrexia seen with abscesses at other sites
focal neurology
e.g. oculomotor nerve palsy or abducens nerve palsy secondary to raised intracranial pressure
other features consistent with raised intracranial pressure
nausea
papilloedema
seizures

Question 3

Investigations

Answer 3

Assessment of the patient includes imaging with CT scanning

Question 4

Management

Answer 4

surgery
a craniotomy is performed and the abscess cavity debrided
the abscess may reform because the head is closed following abscess drainage.
IV antibiotics: IV 3rd-generation cephalosporin + metronidazole
intracranial pressure management: e.g. dexamethasone