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