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Brain or Parameningeal Abscess

Careful attention to risk factors is crucial in diagnosing brain and parameningeal abscess, since patients can have a normal examination, no fever, and no leukocytosis. Patients who are immunocompromised may look well or may be clinically very ill appearing. Predisposing factors include the following:

  • Infectious focus: otitis media, mastoiditis, sinusitis, skin infection (with bacteremia), endocarditis and congenital heart disease, pulmonary infection, dental infection
  • Prior head injury
  • Steroid use and immunosuppression
  • Surgical procedure

Causes

 

Symptoms

  • Headache ++++
  • Focal neurologic deficit +++
  • Nausea and vomiting +++
  • Diffuse neurologic symptoms ++: coma, seizures, behavioral disturbances
  • Subtle personality changes (with frontal lobe abscesses)

Signs

  • Fever +++
  • Toxic appearing ++ (variable)
  • Meningismus ++: (variable, especially with occipital or temporal lobe)
  • Papilledema +++
  • Focal neurologic deficit +++: mild hemiparesis most common

Treatment

   
   

 
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