Materiały źródłowe

• #1 Brain Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441841/

  A brain abscess is a localized area of necrosis within the brain parenchyma, often resulting from infectious agents, such as Staphylococcus and Streptococcus, or trauma or surgery. […] This activity reviews evidence-based approaches to brain abscesses for healthcare professionals, focusing on accurate identification, appropriate imaging modalities, risk factors, and effective treatment strategies. […] Select appropriate imaging techniques, such as CT and MRI, to evaluate suspected brain abscesses accurately. […] Imaging studies are crucial for diagnosing and managing brain abscesses, providing essential information on the lesion’s size, location, and extent. CT and MRI are the primary modalities used, with MRI offering superior sensitivity for detecting early-stage abscesses and distinguishing them from other intracranial pathologies.

• #2 Brain abscess: A narrative review | Neurology perspectives

  https://www.elsevier.es/en-revista-neurology-perspectives-17-articulo-brain-abscess-a-narrative-review-S2667049622000291

  Brain abscess is a severe focal infection of the central nervous system (CNS) with an annual incidence of up to 8% in developing countries. This article aims to present a comprehensive review of the literature on the pathophysiology, clinical presentation, diagnosis, and treatment of brain abscess. […] Diagnosis of brain abscess requires detailed clinical history taking and a thorough physical examination, which help in identifying the predisposing factors and potential pathophysiological mechanisms involved. Due to the variable specificity of clinical findings, neuroimaging and laboratory studies are essential tools in the diagnostic process. […] Neuroimaging studies enable us to determine the localisation, extension, and characteristics of the lesions. Depending on the radiological pattern, which varies according to the developmental stage of the abscess, several differential diagnoses may be considered, ranging from infectious lesions to tumours.

• #3 Brain Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441841/

  Diagnosis is confirmed through imaging and microbiological analysis of the abscess material obtained via aspiration or biopsy. […] Medical management includes antibiotics tailored to the identified pathogens. […] Surgical intervention is indicated for large abscesses greater than 2 cm, those causing significant mass effects, or when a definitive diagnosis is necessary. […] The classic triad of fever, headaches, and focal neurological deficits is observed in less than half of patients. […] CT scans reveal a ring-enhancing lesion with surrounding edema. […] MRI is preferred for better sensitivity, particularly in the early stages.

• #4 Clinical characteristics and outcome of primary brain abscess: a retrospective analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06947-2

  Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. […] We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. […] Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. […] Good outcomes were achieved in 75.44% of the patients. […] Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.11432.407, p=0.037). […] Only a few patients showed the classical triad of clinical symptoms. […] Positive intracranial specimens culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. […] The presence of headache may influence the outcome.

• #5 Brain Abscess: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781021-workup

  Intracranial abscesses are uncommon, serious, life-threatening infections. […] Brain abscess, one of the „big three” central nervous system infections, has historically received less research attention compared to meningitis and encephalitis. […] However, advancements in research, particularly from Northern Europe, have begun to address this gap. […] Notably, Brouwer et al conducted a systematic review and meta-analysis of nearly 10,000 brain abscess cases, providing valuable insights into clinical characteristics and outcomes. […] Brain abscess is caused by intracranial inflammation with subsequent abscess formation. […] The most frequent causative pathogens in community-acquired brain abscess are oral cavity bacteria such as Streptococcus anginosus group, Fusobacterium spp, and Aggregatibacter spp, which are often associated with dental and chronic ear infections.

• #6 Clinical characteristics and outcome of primary brain abscess: a retrospective analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06947-2

  Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. […] We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. […] Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. […] Good outcomes were achieved in 75.44% of the patients. […] Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.11432.407, p=0.037). […] Only a few patients showed the classical triad of clinical symptoms. […] Positive intracranial specimens culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. […] The presence of headache may influence the outcome.

• #7 Treatment and prognosis of bacterial brain abscess – UpToDate

  https://www.uptodate.com/contents/treatment-and-prognosis-of-bacterial-brain-abscess

  Brain abscess is a focal collection within the brain parenchyma, which can arise as a complication of a variety of infections, trauma, or surgery. The diagnosis of brain abscess requires a high index of suspicion since it can have a subtle presentation. Successful treatment requires a combination of surgical drainage and antimicrobial therapy. […] Most patients with brain abscess require surgical drainage, in addition to antibiotics, for both diagnostic and therapeutic purposes. […] A neurosurgeon should be contacted at the time of initial diagnosis of brain abscess in all patients. In nearly all cases needle aspiration or surgical excision is recommended as soon as possible to identify the causative pathogen prior to the initiation of antibiotic therapy and to reduce the size of the collection. It is important that the aspirate be cultured for aerobes and anaerobes, fungi, and Mycobacterium tuberculosis. […] However, under certain circumstances, drainage of a presumed bacterial brain abscess may be delayed or not required.

• #8 Brain Abscess – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK441841/

  A brain abscess is a localized area of necrosis within the brain parenchyma, often resulting from infectious agents, such as Staphylococcus and Streptococcus, or trauma or surgery. […] This activity reviews evidence-based approaches to brain abscesses for healthcare professionals, focusing on accurate identification, appropriate imaging modalities, risk factors, and effective treatment strategies. […] Select appropriate imaging techniques, such as CT and MRI, to evaluate suspected brain abscesses accurately. […] Imaging studies are crucial for diagnosing and managing brain abscesses, providing essential information on the lesion’s size, location, and extent. CT and MRI are the primary modalities used, with MRI offering superior sensitivity for detecting early-stage abscesses and distinguishing them from other intracranial pathologies.

• #9 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #10 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  When symptoms indicate the presence of an abscess, a contrast-enhanced MRI with diffusion-weighted imaging is preferred; if MRI is not available, a contrast-enhanced CT scan is performed. A fully developed abscess typically presents as an edematous mass with ring enhancement, which can be challenging to differentiate from a brain tumor or, in some cases, an infarction. Therefore, procedures such as CT-guided aspiration, culture, surgical excision, or a combination of these may be required. […] Culturing the pus obtained from the abscess allows for targeted antibiotic therapy. However, it is important to initiate antibiotic treatment without delay, even before culture results are available. […] Many authorities consider MRI to be the first diagnostic method in the diagnosis of brain abscess. It allows for accurate diagnosis and excellent follow-up of the lesions because of its superior sensitivity and specificity. Compared with CT scanning, MRI offers a better ability to detect cerebritis, greater contrast between cerebral edema and the brain, better visualization of the brainstem, and earlier detection of satellite lesions and the spread of inflammation into the ventricles and subarachnoid space.

• #11 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  When symptoms indicate the presence of an abscess, a contrast-enhanced MRI with diffusion-weighted imaging is preferred; if MRI is not available, a contrast-enhanced CT scan is performed. A fully developed abscess typically presents as an edematous mass with ring enhancement, which can be challenging to differentiate from a brain tumor or, in some cases, an infarction. Therefore, procedures such as CT-guided aspiration, culture, surgical excision, or a combination of these may be required. […] Culturing the pus obtained from the abscess allows for targeted antibiotic therapy. However, it is important to initiate antibiotic treatment without delay, even before culture results are available. […] Many authorities consider MRI to be the first diagnostic method in the diagnosis of brain abscess. It allows for accurate diagnosis and excellent follow-up of the lesions because of its superior sensitivity and specificity. Compared with CT scanning, MRI offers a better ability to detect cerebritis, greater contrast between cerebral edema and the brain, better visualization of the brainstem, and earlier detection of satellite lesions and the spread of inflammation into the ventricles and subarachnoid space.

• #12 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #13 Cerebral abscess | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cerebral-abscess-1?lang=us

  A cerebral abscess is a focal area of necrosis starting in an area of cerebritis surrounded by a membrane. It is a potentially life-threatening condition requiring prompt radiological identification and rapid treatment. Fortunately, MRI is usually able to convincingly make the diagnosis, distinguishing abscesses from other ring-enhancing lesions. […] Both CT and MRI demonstrate similar features, although MRI has a greater ability to distinguish a cerebral abscess from other ring-enhancing lesions. […] MRI is more sensitive than CT. Although peripherally-enhancing lesions may be non-specific by imaging, diffusion-weighted sequences (less commonly MR spectroscopy) showing central diffusion restriction are critical for suggesting the diagnosis of a cerebral abscess. […] The mainstay of treatment for cerebral abscesses is neurosurgical intervention and drainage of the collection. This can be performed either by stereotactic aspiration or craniotomy. Broad-spectrum intravenous antibiotics are also needed and can later be changed to agents tailored to the specific organisms. […] In cases where the abscess cavity does not completely obliterate, follow-up with MRI including DWI is useful and lack of restricted diffusion is reassuring. Demonstration of ongoing restricted diffusion in a cavity suggests persistent infection.

• #14 Cerebral abscess | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cerebral-abscess-1?lang=us

  A cerebral abscess is a focal area of necrosis starting in an area of cerebritis surrounded by a membrane. It is a potentially life-threatening condition requiring prompt radiological identification and rapid treatment. Fortunately, MRI is usually able to convincingly make the diagnosis, distinguishing abscesses from other ring-enhancing lesions. […] Both CT and MRI demonstrate similar features, although MRI has a greater ability to distinguish a cerebral abscess from other ring-enhancing lesions. […] MRI is more sensitive than CT. Although peripherally-enhancing lesions may be non-specific by imaging, diffusion-weighted sequences (less commonly MR spectroscopy) showing central diffusion restriction are critical for suggesting the diagnosis of a cerebral abscess. […] The mainstay of treatment for cerebral abscesses is neurosurgical intervention and drainage of the collection. This can be performed either by stereotactic aspiration or craniotomy. Broad-spectrum intravenous antibiotics are also needed and can later be changed to agents tailored to the specific organisms. […] In cases where the abscess cavity does not completely obliterate, follow-up with MRI including DWI is useful and lack of restricted diffusion is reassuring. Demonstration of ongoing restricted diffusion in a cavity suggests persistent infection.

• #15 Brain abscess: A narrative review | Neurology perspectives

  https://www.elsevier.es/en-revista-neurology-perspectives-17-articulo-brain-abscess-a-narrative-review-S2667049622000291

  In up to 85% of cases, contrast-enhanced head CT reveals a lesion with a hypodense nucleus (necrosis) surrounded by a thin contrast-enhancing ring (capsule) and perilesional oedema of variable extension. […] Contrast-enhanced brain MRI is the diagnostic technique of choice due to its high sensitivity and specificity. This technique is able to detect early cerebritis, intraventricular and subarachnoid infectious dissemination, and satellite lesions. […] On DWI sequences, bacterial brain abscesses display signal hyperintensity, with low ADC values. Tumoural lesions appear hypointense and present high ADC values. Recognising this pattern decreases diagnostic errors, improving the sensitivity and specificity of MRI. […] The most common signs and symptoms are headache, fever, focal neurological deficits, and impaired consciousness. Laboratory findings are nonspecific, with leukocytosis, elevated CRP levels, pleocytosis, and elevated CSF protein levels being the most frequent findings.

• #16 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  Diffusion-weighted (magnetic resonance) imaging (DWI) can be used to differentiate between ring-enhancing lesions caused by brain abscess (hypertensive on DWI) from a malignant lesion (hypotensive on DWI). […] CT scanning has made other tests, such as angiography, ventriculography, pneumoencephalography, and radionuclide brain scanning, almost obsolete in the workup of brain abscess. CT is not as sensitive as MRI but is easier to perform. […] After the injection of a contrast material, CT scans characteristically show the brain abscess as a hypodense center with a peripheral uniform enhancement ring. Rarely, a well-organized abscess wall fails to generate such ring enhancement.

• #17 Brain abscess differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Brain_abscess_differential_diagnosis

  Brain abscess must be differentiated from metastatic tumors, necrotic tumors, and lymphomas. […] Diagnosis of brain abscesses and necrotic tumors is often impossible without conventional MR imaging. […] Several studies demonstrate the utility of Diffusion-weighted imaging (DWI) to differentiate between necrotic or cystic lesions and brain abscesses. […] DWI has a sensitivity and specificity of over 90% for distinguishing abscess (low ADC) from necrotic tumors (high ADC). […] Despite these differences, the true diagnosis is sometimes not made until biopsy. […] Contrast enhanced MRI is more sensitive and specific. […] MRI: Diffusion-weighted imaging (DWI) MRI can differentiate brain abscesses from cystic brain lesions with sensitivity and specificity of 96%.

• #18 Brain abscess: A narrative review | Neurology perspectives

  https://www.elsevier.es/en-revista-neurology-perspectives-17-articulo-brain-abscess-a-narrative-review-S2667049622000291

  In up to 85% of cases, contrast-enhanced head CT reveals a lesion with a hypodense nucleus (necrosis) surrounded by a thin contrast-enhancing ring (capsule) and perilesional oedema of variable extension. […] Contrast-enhanced brain MRI is the diagnostic technique of choice due to its high sensitivity and specificity. This technique is able to detect early cerebritis, intraventricular and subarachnoid infectious dissemination, and satellite lesions. […] On DWI sequences, bacterial brain abscesses display signal hyperintensity, with low ADC values. Tumoural lesions appear hypointense and present high ADC values. Recognising this pattern decreases diagnostic errors, improving the sensitivity and specificity of MRI. […] The most common signs and symptoms are headache, fever, focal neurological deficits, and impaired consciousness. Laboratory findings are nonspecific, with leukocytosis, elevated CRP levels, pleocytosis, and elevated CSF protein levels being the most frequent findings.

• #19 Brain abscess differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Brain_abscess_differential_diagnosis

  Brain abscess must be differentiated from metastatic tumors, necrotic tumors, and lymphomas. […] Diagnosis of brain abscesses and necrotic tumors is often impossible without conventional MR imaging. […] Several studies demonstrate the utility of Diffusion-weighted imaging (DWI) to differentiate between necrotic or cystic lesions and brain abscesses. […] DWI has a sensitivity and specificity of over 90% for distinguishing abscess (low ADC) from necrotic tumors (high ADC). […] Despite these differences, the true diagnosis is sometimes not made until biopsy. […] Contrast enhanced MRI is more sensitive and specific. […] MRI: Diffusion-weighted imaging (DWI) MRI can differentiate brain abscesses from cystic brain lesions with sensitivity and specificity of 96%.

• #20 Diagnosis of brain abscess by magnetic resonance spectroscopy in: Journal of Neurosurgery Volume 86 Issue 4 (1997) Journals

  https://thejns.org/view/journals/j-neurosurg/86/4/article-p708.xml

  Two cases of brain abscess were diagnosed by combining magnetic resonance spectroscopy (MRS) and magnetic resonance (MR) imaging. […] The technique of MRS was demonstrated to be very powerful in the differential diagnosis of brain abscesses from other brain pathologies such as neoplasms. […] MRS complemented the information provided by MR imaging to achieve a correct diagnosis of brain abscesses and could be added to routine MR examinations with only a small increase in cost and time.

• #21 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #22 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  Diffusion-weighted (magnetic resonance) imaging (DWI) can be used to differentiate between ring-enhancing lesions caused by brain abscess (hypertensive on DWI) from a malignant lesion (hypotensive on DWI). […] CT scanning has made other tests, such as angiography, ventriculography, pneumoencephalography, and radionuclide brain scanning, almost obsolete in the workup of brain abscess. CT is not as sensitive as MRI but is easier to perform. […] After the injection of a contrast material, CT scans characteristically show the brain abscess as a hypodense center with a peripheral uniform enhancement ring. Rarely, a well-organized abscess wall fails to generate such ring enhancement.

• #23 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  Diffusion-weighted (magnetic resonance) imaging (DWI) can be used to differentiate between ring-enhancing lesions caused by brain abscess (hypertensive on DWI) from a malignant lesion (hypotensive on DWI). […] CT scanning has made other tests, such as angiography, ventriculography, pneumoencephalography, and radionuclide brain scanning, almost obsolete in the workup of brain abscess. CT is not as sensitive as MRI but is easier to perform. […] After the injection of a contrast material, CT scans characteristically show the brain abscess as a hypodense center with a peripheral uniform enhancement ring. Rarely, a well-organized abscess wall fails to generate such ring enhancement.

• #24 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  Diffusion-weighted (magnetic resonance) imaging (DWI) can be used to differentiate between ring-enhancing lesions caused by brain abscess (hypertensive on DWI) from a malignant lesion (hypotensive on DWI). […] CT scanning has made other tests, such as angiography, ventriculography, pneumoencephalography, and radionuclide brain scanning, almost obsolete in the workup of brain abscess. CT is not as sensitive as MRI but is easier to perform. […] After the injection of a contrast material, CT scans characteristically show the brain abscess as a hypodense center with a peripheral uniform enhancement ring. Rarely, a well-organized abscess wall fails to generate such ring enhancement.

• #25

  https://www.nhs.uk/conditions/brain-abscess/treatment/

  The abscess is then drained of pus or totally removed. CT guidance may be used during the operation, to allow the surgeon to more accurately locate the exact position of the abscess. […] Once your brain abscess has been treated, you’ll probably stay in hospital for several weeks so your body can be supported while you recover. […] You’ll also receive a number of CT scans, to make sure the brain abscess has been completely removed.

• #26

  https://www.nhs.uk/conditions/brain-abscess/

  If a brain abscess is suspected, an initial assessment will be made based on your symptoms, medical history and whether you’ve had a recent infection or a weakened immune system. […] Blood tests can also be carried out to check for an infection. […] If you’re referred to hospital for further tests, you may have either: a CT scan a series of X-rays are used to produce a detailed image of the inside of your body or an MRI scan which uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body. […] If an abscess is found, a procedure known as CT-guided aspiration may be used to remove a sample of pus for testing. This involves using a CT scan to guide a needle to the site of the abscess.

• #27

  https://www.nhs.uk/conditions/brain-abscess/treatment/

  The abscess is then drained of pus or totally removed. CT guidance may be used during the operation, to allow the surgeon to more accurately locate the exact position of the abscess. […] Once your brain abscess has been treated, you’ll probably stay in hospital for several weeks so your body can be supported while you recover. […] You’ll also receive a number of CT scans, to make sure the brain abscess has been completely removed.

• #28 Brain Abscess Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/212946-workup

  Diffusion-weighted (magnetic resonance) imaging (DWI) can be used to differentiate between ring-enhancing lesions caused by brain abscess (hypertensive on DWI) from a malignant lesion (hypotensive on DWI). […] CT scanning has made other tests, such as angiography, ventriculography, pneumoencephalography, and radionuclide brain scanning, almost obsolete in the workup of brain abscess. CT is not as sensitive as MRI but is easier to perform. […] After the injection of a contrast material, CT scans characteristically show the brain abscess as a hypodense center with a peripheral uniform enhancement ring. Rarely, a well-organized abscess wall fails to generate such ring enhancement.

• #29 Brain Abscess: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/brain-abscess

  A brain abscess is a collection of pus and other materials in your brain. […] A healthcare provider will diagnose a brain abscess after a neurological exam and testing. This exam will show that you have increased pressure within your skull and, as a result, your brain isnt functioning as expected. […] To confirm a diagnosis, your provider will offer tests like: Blood tests (blood culture and complete blood count). Imaging tests (MRI and/or a CT scan). Electroencephalogram (EEG). […] A brain abscess is a medical emergency that requires immediate attention. Treatment for a brain abscess includes: Medications: Youll receive antibiotics or antifungal medications to treat the abscess. […] A healthcare provider will consider medications if: The abscess is less than 2 centimeters in size. The abscess is deep within your brain.

• #30 What Is a Brain Abscess?

  https://www.icliniq.com/articles/neurological-health/brain-abscess

  Brain abscess is diagnosed based on clinical findings, patient history, laboratory, and imaging tests. […] Medical History: The doctor will enquire regarding the recent history of infection, weak immune system, and other relevant questions related to the condition. […] Blood Tests: A complete blood count helps check the levels of white blood cells, which increase in number during an infection. […] Imaging Modalities: Scans such as CT (computed tomography) scan and MRI (magnetic resonance imaging) will determine the lesion’s location, dimensions, and extent. […] CT-Guided Aspiration: It is a type of biopsy where a needle is inserted into the abscess, and a sample of the pus is collected. This sample is then analyzed for specific microbes and other contents.

• #31 Brain abscess in children in: Neurosurgical Focus Volume 24 Issue 6 (2008) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/24/6/article-pE6.xml

  Blood cultures are rarely positive and obtaining CSF by lumbar puncture in the presence of a brain abscess can be life threatening. […] Although cerebritis, small solitary abscesses ( 2 cm in diameter), or those in which the causative agent has been identified can be treated with antimicrobials alone, strong consideration should be given to surgical drainage followed by the prompt initiation of empirical broad-spectrum empiric antimicrobial therapy. […] Serial neuroimaging must be performed to document an improvement in and eventually a resolution of the infection. Surgical treatment with either needle aspiration or excision remains an important part of the treatment algorithm for pediatric patients afflicted with brain abscesses.

• #32 Brain abscess – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/925

  Brain abscess is a potentially life-threatening condition, with clinical and radiological presentation similar to central nervous system tumour. Early recognition is required for optimal outcome. […] Patients must be followed up with serial imaging until their lesions have completely resolved. […] Key diagnostic factors include presence of risk factors, male sex, age 30 years, meningismus, headache, cranial nerve palsy, positive Kernig or Brudzinski sign, fever, increased head circumference (infants), and bulging fontanelles (infants). […] 1st investigations to order include FBC, serum erythrocyte sedimentation rate (ESR), serum CRP, serum PT, PTT, and INR, blood culture, MRI with contrast, CT head with and without contrast, and ultrasound head (infants).

• #33 Brain abscess – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/925

  Brain abscess is a potentially life-threatening condition, with clinical and radiological presentation similar to central nervous system tumour. Early recognition is required for optimal outcome. […] Patients must be followed up with serial imaging until their lesions have completely resolved. […] Key diagnostic factors include presence of risk factors, male sex, age 30 years, meningismus, headache, cranial nerve palsy, positive Kernig or Brudzinski sign, fever, increased head circumference (infants), and bulging fontanelles (infants). […] 1st investigations to order include FBC, serum erythrocyte sedimentation rate (ESR), serum CRP, serum PT, PTT, and INR, blood culture, MRI with contrast, CT head with and without contrast, and ultrasound head (infants).

• #34 Pyogenic brain abscess, a 15 year survey | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-12-332

  Brain abscess is a potentially fatal disease. This study assesses clinical aspects of brain abscess in a large hospital cohort. […] The clinical signs of brain abscess are unspecific, many patients presented without clear signs of infection and diagnosis and treatment were often delayed. Decreased GCS, presence of comorbidities and intraventricular rupture of brain abscess were associated with poor outcome. Brain abscess remains associated with considerable morbidity and mortality. […] The majority of patients presented with uncharacteristic symptoms and diagnosis was frequently delayed. The usual signs of infection such as fever, increased WBC and increased phase reactants were only present in 60% at presentation. Although fever was the single most common presenting symptom, 42% displayed no febrile symptoms. It is a common misconception that fever is necessarily a part of the presenting scheme of cerebral abscess.

• #35 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #36

  https://www.nhs.uk/conditions/brain-abscess/

  If a brain abscess is suspected, an initial assessment will be made based on your symptoms, medical history and whether you’ve had a recent infection or a weakened immune system. […] Blood tests can also be carried out to check for an infection. […] If you’re referred to hospital for further tests, you may have either: a CT scan a series of X-rays are used to produce a detailed image of the inside of your body or an MRI scan which uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body. […] If an abscess is found, a procedure known as CT-guided aspiration may be used to remove a sample of pus for testing. This involves using a CT scan to guide a needle to the site of the abscess.

• #37 Brain abscess – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/brain-abscess/

  Brain abscess is a focal suppurative process of the brain parenchyma. […] Brain imaging studies should be performed. Magnetic resonance imaging (MRI) with gadolinium contrast is more sensitive and specific than computed tomography (CT) with contrast. […] The diagnosis of brain abscess can be challenging in patients in whom a single ring-enhancing lesion with perifocal edema has been identified on CT, giving rise to the differential diagnosis of abscess versus necrotic tumor (glioblastoma) or metastasis. […] Once a diagnosis of brain abscess is considered after radiographic imaging, microbiologic diagnosis should be performed, including processing the samples for Gram stain and other stains if indicated (stain for fungal organisms and acid-fast bacilli) as well as obtaining cultures for both aerobic and anerobic organisms.

• #38 Brain abscess – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/brain-abscess/

  Brain abscess is a focal suppurative process of the brain parenchyma. […] Brain imaging studies should be performed. Magnetic resonance imaging (MRI) with gadolinium contrast is more sensitive and specific than computed tomography (CT) with contrast. […] The diagnosis of brain abscess can be challenging in patients in whom a single ring-enhancing lesion with perifocal edema has been identified on CT, giving rise to the differential diagnosis of abscess versus necrotic tumor (glioblastoma) or metastasis. […] Once a diagnosis of brain abscess is considered after radiographic imaging, microbiologic diagnosis should be performed, including processing the samples for Gram stain and other stains if indicated (stain for fungal organisms and acid-fast bacilli) as well as obtaining cultures for both aerobic and anerobic organisms.

• #39 Brain abscess – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/brain-abscess/

  Brain abscess is a focal suppurative process of the brain parenchyma. […] Brain imaging studies should be performed. Magnetic resonance imaging (MRI) with gadolinium contrast is more sensitive and specific than computed tomography (CT) with contrast. […] The diagnosis of brain abscess can be challenging in patients in whom a single ring-enhancing lesion with perifocal edema has been identified on CT, giving rise to the differential diagnosis of abscess versus necrotic tumor (glioblastoma) or metastasis. […] Once a diagnosis of brain abscess is considered after radiographic imaging, microbiologic diagnosis should be performed, including processing the samples for Gram stain and other stains if indicated (stain for fungal organisms and acid-fast bacilli) as well as obtaining cultures for both aerobic and anerobic organisms.

• #40 Brain Abscess | Johns Hopkins ABX Guide

  https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540065/all/Brain_Abscess

  In 80-90% of brain abscesses, multiple organisms are recovered by culture (even more with molecular techniques). […] Early infection = cerebritis, subsequent necrosis and capsule formation abscess. […] There’s more to see — the rest of this topic is available only to subscribers.

• #41 Brain Abscess: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781021-workup

  Intracranial abscesses are uncommon, serious, life-threatening infections. […] Brain abscess, one of the „big three” central nervous system infections, has historically received less research attention compared to meningitis and encephalitis. […] However, advancements in research, particularly from Northern Europe, have begun to address this gap. […] Notably, Brouwer et al conducted a systematic review and meta-analysis of nearly 10,000 brain abscess cases, providing valuable insights into clinical characteristics and outcomes. […] Brain abscess is caused by intracranial inflammation with subsequent abscess formation. […] The most frequent causative pathogens in community-acquired brain abscess are oral cavity bacteria such as Streptococcus anginosus group, Fusobacterium spp, and Aggregatibacter spp, which are often associated with dental and chronic ear infections.

• #42 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #43 Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case

  https://www.mdpi.com/2673-8449/3/4/18

  Pathogen identification is crucial and has led to many decisions in the management of patients. […] However, microbiological documentation of brain abscesses is challenging. […] To overcome these limits, molecular approaches can be used in addition to culture. […] New molecular techniques such as SMg are freeing themselves from these limits. […] Compared to conventional culture and sequencing of the 16S rRNA gene, SMg appeared to be more informative for bacterial documentation. […] This highlights the fact that diagnosing central nervous system tuberculosis is difficult. […] A literature review on SMg use for brain abscesses microbiological documentation retrieved only fifteen other cases published as case reports or short series. […] However, only cases with positive results have been published, which highlights the need for prospective studies to evaluate the diagnostic performance of brain abscesses.

• #44 Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case

  https://www.mdpi.com/2673-8449/3/4/18

  Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case […] Shotgun metagenomics (SMg) usefulness for brain abscess diagnosis is not known. […] Microbiological documentation of brain abscesses is challenging with routine microbiological techniques as cultures remain negative in one-third of cases. […] Rapid identification of pathogens is essential to guide antimicrobial management. […] The SMg approach is revolutionizing some infectious diseases research fields with the discovery of new pathogens and the analysis of microbiomes; however, its place in clinical routine is still not well characterized. […] In the present case, conventional microbiology methods and Sanger sequencing of the 16S rRNA gene failed to identify the causative pathogens when SMg succeeded.

• #45 Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case

  https://www.mdpi.com/2673-8449/3/4/18

  Pathogen identification is crucial and has led to many decisions in the management of patients. […] However, microbiological documentation of brain abscesses is challenging. […] To overcome these limits, molecular approaches can be used in addition to culture. […] New molecular techniques such as SMg are freeing themselves from these limits. […] Compared to conventional culture and sequencing of the 16S rRNA gene, SMg appeared to be more informative for bacterial documentation. […] This highlights the fact that diagnosing central nervous system tuberculosis is difficult. […] A literature review on SMg use for brain abscesses microbiological documentation retrieved only fifteen other cases published as case reports or short series. […] However, only cases with positive results have been published, which highlights the need for prospective studies to evaluate the diagnostic performance of brain abscesses.

• #46 European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37648062/

  These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. […] Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). […] Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). […] Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low).

• #47 Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case

  https://www.mdpi.com/2673-8449/3/4/18

  SMg is a promising new molecular identification method of particular interest in this disease considering its characteristics: high morbidity, polymicrobial and/or anaerobic-caused infection, frequent use of antibiotics prior to sampling. […] As physicians begin to include SMg in clinical practice, this approach needs to be more accessible at reasonable cost and delay.

• #48 Brain Abscess » Lillian S. Wells Department of Neurosurgery at the University of Florida » College of Medicine » University of Florida

  https://neurosurgery.ufl.edu/patient-care/diseases-conditions/brain-abscess/

  The diagnosis is usually made by a combination of the history, physical exam and brain imaging. MRI with and without contrast is the study of choice. […] Unlike other brain infections, a brain abscess is usually not diagnosed by CSF studies. […] Lumbar puncture actually may be contraindicated in these patients secondary to the mass effect the abscess has on the brain. If CSF is removed, the swollen brain can shift into small openings in the dura and skull causing neurological deterioration.

• #49 Brain abscess – UF Health

  https://ufhealth.org/conditions-and-treatments/brain-abscess

  The diagnosis is usually made by a combination of the history, physical exam and brain imaging. […] MRI with and without contrast is the study of choice. […] Unlike other brain infections, a brain abscess is usually not diagnosed by CSF studies. […] Lumbar puncture actually may be contraindicated in these patients secondary to the mass effect the abscess has on the brain.

• #50 Brain abscess – Wikipedia

  https://en.wikipedia.org/wiki/Brain_abscess

  Lumbar puncture procedure, which is performed in many infectious disorders of the central nervous system is contraindicated in this condition (as it is in all space-occupying lesions of the brain) because removing a certain portion of the cerebrospinal fluid may alter the concrete intracranial pressure balances and causes the brain tissue to move across structures within the skull (brain herniation). […] Ring enhancement may also be observed in cerebral hemorrhages (bleeding) and some brain tumors. However, in the presence of the rapidly progressive course with fever, focal neurologic findings (hemiparesis, aphasia etc.) and signs of increased intracranial pressure, the most likely diagnosis should be the brain abscess.

• #51 Brain abscess – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/brain-abscess/

  Obtain infectious diseases and neurosurgery consults. […] Initial studies include brain imaging (CT/MRI) and laboratory studies, including blood cultures. […] Confirmatory study: abscess sampling, usually done by neurosurgery. […] Brain imaging is used as an initial test to confirm and characterize intracranial lesions, then to monitor treatment response. […] MRI brain with and without contrast (preferred) is used to identify characteristics of the abscess. […] CT head with IV contrast shows intraparenchymal lesions with a central hypodense (necrotic) area and peripheral ring enhancement. […] Blood cultures should be obtained prior to starting antibiotics. […] Lumbar puncture is relatively contraindicated in patients with a suspected brain abscess and not routinely performed.

• #52 Brain Abscess | Concise Medical Knowledge

  https://www.lecturio.com/concepts/brain-abscess/

  Diagnosis is mainly based on imaging, as it is difficult to arrive at a definitive diagnosis based on clinical presentation alone. […] MRI: More sensitive than CT scan. […] Classic ring enhancement is observed. […] CT scan: Not as sensitive as MRI and therefore mostly used only in emergencies. […] Early cerebritis appears as an irregular area of low density. […] Ring enhancement is not as clear as in MRI. […] Lumbar puncture: Performed to exclude meningitis from differential. […] Obtain brain imaging first to rule out intracerebral mass due to risk of brainstem herniation. […] Abscess aspirate/biopsy: Obtained via image-guided aspiration or during surgical intervention. […] Histopathology: Gives a definitive diagnosis.

• #53

  https://link.springer.com/article/10.1007/BF01781960

  The diagnosis of brain abscesses has been improved during the last 10 years because to introduction of computerized tomography (CCT) and improved methods for the analysis of cerebrospinal fluid (CSF). […] Typical ring-like enhancement in the CT and an elevated CSF cell count combined with disturbances of the blood-brain barrier and elevated CSF lactate are common and confirm preliminary diagnoses. […] However, in spite of these procedures, brain abscess is still sometimes misdiagnosed because of the lack of pathological CT findings or a misleading case history sometimes causing cerebral affections. […] We recommend the immediate performance of contrast-enhanced CT and CSF analysis. […] If these procedures do not exclude a brain abscess, antibiotic treatment should be begun immediately.

• #54

  https://link.springer.com/article/10.1007/BF01781960

  The diagnosis of brain abscesses has been improved during the last 10 years because to introduction of computerized tomography (CCT) and improved methods for the analysis of cerebrospinal fluid (CSF). […] Typical ring-like enhancement in the CT and an elevated CSF cell count combined with disturbances of the blood-brain barrier and elevated CSF lactate are common and confirm preliminary diagnoses. […] However, in spite of these procedures, brain abscess is still sometimes misdiagnosed because of the lack of pathological CT findings or a misleading case history sometimes causing cerebral affections. […] We recommend the immediate performance of contrast-enhanced CT and CSF analysis. […] If these procedures do not exclude a brain abscess, antibiotic treatment should be begun immediately.

• #55

  https://link.springer.com/article/10.1007/BF01781960

  The diagnosis of brain abscesses has been improved during the last 10 years because to introduction of computerized tomography (CCT) and improved methods for the analysis of cerebrospinal fluid (CSF). […] Typical ring-like enhancement in the CT and an elevated CSF cell count combined with disturbances of the blood-brain barrier and elevated CSF lactate are common and confirm preliminary diagnoses. […] However, in spite of these procedures, brain abscess is still sometimes misdiagnosed because of the lack of pathological CT findings or a misleading case history sometimes causing cerebral affections. […] We recommend the immediate performance of contrast-enhanced CT and CSF analysis. […] If these procedures do not exclude a brain abscess, antibiotic treatment should be begun immediately.

• #56 Brain Abscess: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/brain-abscess

  A brain abscess is a collection of pus and other materials in your brain. […] A healthcare provider will diagnose a brain abscess after a neurological exam and testing. This exam will show that you have increased pressure within your skull and, as a result, your brain isnt functioning as expected. […] To confirm a diagnosis, your provider will offer tests like: Blood tests (blood culture and complete blood count). Imaging tests (MRI and/or a CT scan). Electroencephalogram (EEG). […] A brain abscess is a medical emergency that requires immediate attention. Treatment for a brain abscess includes: Medications: Youll receive antibiotics or antifungal medications to treat the abscess. […] A healthcare provider will consider medications if: The abscess is less than 2 centimeters in size. The abscess is deep within your brain.

• #57 Brain Abscess | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/brain-abscess

  Lumbar puncture, also called a spinal tap, measures the pressure in the spinal canal and brain. […] Electroencephalogram, also called an EEG, records the brain’s continuous, electrical activity by means of electrodes attached to your scalp. […] Intracranial pressure monitoring, also called ICP, measures the pressure inside of your head.

• #58 Brain Abscess | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/brain-abscess

  Lumbar puncture, also called a spinal tap, measures the pressure in the spinal canal and brain. […] Electroencephalogram, also called an EEG, records the brain’s continuous, electrical activity by means of electrodes attached to your scalp. […] Intracranial pressure monitoring, also called ICP, measures the pressure inside of your head.

• #59 Brain abscess Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/brain-abscess

  A brain abscess is a collection of pus, immune cells, and other material in the brain, caused by a bacterial or fungal infection. […] A brain and nervous system (neurological) exam will usually show signs of increased pressure inside the skull and problems with brain function. […] Tests to diagnose a brain abscess may include: Blood cultures, Chest x-ray, Complete blood count (CBC), Head CT scan, Electroencephalogram (EEG), MRI of head, Testing for the presence of antibodies to certain germs. […] A needle biopsy is usually performed to identify the cause of the infection.

• #60 Brain Abscess Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/brain-abscess

  Blood tests […] Urine and stool tests […] Sputum culture: a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. […] Lumbar puncture (spinal tap): a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured.

• #61 Brain Abscess Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/brain-abscess

  Blood tests […] Urine and stool tests […] Sputum culture: a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. […] Lumbar puncture (spinal tap): a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured.

• #62 Brain abscess – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/925

  Brain abscess is a potentially life-threatening condition, with clinical and radiologic presentation similar to central nervous system tumor. Early recognition is required for optimal outcome. […] Patients must be followed up with serial imaging until their lesions have completely resolved. […] Key diagnostic factors include male sex, age 30 years, meningismus, headache, cranial nerve palsy, positive Kernig or Brudzinski sign, fever, increased head circumference (infants), and bulging fontanelles (infants). […] Diagnostic tests include CBC, serum erythrocyte sedimentation rate (ESR), serum CRP, serum PT, PTT, and INR, blood culture, MRI with contrast, CT head with and without contrast, and ultrasound head (infants). […] Tests to consider include serum toxoplasma titer, magnetic resonance spectroscopy (MRS), lumbar puncture (LP) with cerebrospinal fluid (CSF) analysis, CT chest, abdomen, and pelvis, bone scan, and mammogram.

• #63 Brain Abscess: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781021-workup

  Intracranial abscesses are uncommon, serious, life-threatening infections. […] Brain abscess, one of the „big three” central nervous system infections, has historically received less research attention compared to meningitis and encephalitis. […] However, advancements in research, particularly from Northern Europe, have begun to address this gap. […] Notably, Brouwer et al conducted a systematic review and meta-analysis of nearly 10,000 brain abscess cases, providing valuable insights into clinical characteristics and outcomes. […] Brain abscess is caused by intracranial inflammation with subsequent abscess formation. […] The most frequent causative pathogens in community-acquired brain abscess are oral cavity bacteria such as Streptococcus anginosus group, Fusobacterium spp, and Aggregatibacter spp, which are often associated with dental and chronic ear infections.

• #64 BRAIN ABSCESS | Harrison’s Manual of Medicine

  https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623483/all/BRAIN_ABSCESS

  A focal, suppurative infection within the brain parenchyma, typically surrounded by a vascularized capsule. […] Predisposing conditions include otitis media and mastoiditis, paranasal sinusitis, pyogenic infections in the chest or other body sites, head trauma, neurosurgical procedures, and dental infections. […] Many brain abscesses occur in immunocompromised hosts and are caused less often by bacteria than by fungi and parasites including Toxoplasma gondii, Aspergillus spp., Nocardia spp., Candida spp., and Cryptococcus neoformans. […] In Latin America, the most common cause of brain abscess is Taenia solium (neurocysticercosis). […] In India and the Far East, mycobacterial infection (tuberculoma) remains a major cause of focal CNS mass lesions.

• #65

  https://www.nhs.uk/conditions/brain-abscess/

  If a brain abscess is suspected, an initial assessment will be made based on your symptoms, medical history and whether you’ve had a recent infection or a weakened immune system. […] Blood tests can also be carried out to check for an infection. […] If you’re referred to hospital for further tests, you may have either: a CT scan a series of X-rays are used to produce a detailed image of the inside of your body or an MRI scan which uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body. […] If an abscess is found, a procedure known as CT-guided aspiration may be used to remove a sample of pus for testing. This involves using a CT scan to guide a needle to the site of the abscess.

• #66 Brain Abscess | Loma Linda University Health

  https://lluh.org/conditions/brain-abscess

  A cerebral abscess can cause many symptoms, including: […] How is a cerebral abscess diagnosed? […] Your healthcare provider will ask about your symptoms. They may do a neurological exam to look for changes in motor and sensory function, vision, coordination, and balance. Your healthcare provider will also check your mental status and mood or behavior. You may also need tests, such as: […] MRI or CT scan of your head […] Blood tests to look for signs of germs and other signs of infection […] Tests of a sample from the abscess to determine the cause of your infection. […] A cerebral abscess is an infection in your brain. It is a medical emergency that needs treatment right away. […] Symptoms can include headache, fever, changes in consciousness, confusion, neck stiffness, vomiting, seizures, weakness, trouble moving, and changes in vision. […] Treatment is with strong antibiotics. You may also take other medicines, such as steroids or those to prevent seizures. Surgery might be needed to drain the fluid from the abscess or to remove it completely.

• #67 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #68 Brain Abscess: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/brain-abscess

  A brain abscess is a collection of pus and other materials in your brain. […] A healthcare provider will diagnose a brain abscess after a neurological exam and testing. This exam will show that you have increased pressure within your skull and, as a result, your brain isnt functioning as expected. […] To confirm a diagnosis, your provider will offer tests like: Blood tests (blood culture and complete blood count). Imaging tests (MRI and/or a CT scan). Electroencephalogram (EEG). […] A brain abscess is a medical emergency that requires immediate attention. Treatment for a brain abscess includes: Medications: Youll receive antibiotics or antifungal medications to treat the abscess. […] A healthcare provider will consider medications if: The abscess is less than 2 centimeters in size. The abscess is deep within your brain.

• #69 Brain Abscess | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/brain-abscess

  A brain abscess can be detected through a variety of tests, including X-rays, MRIs, and CT scans. […] During the physical examination, your child’s doctor will obtain a complete medical history of your child. In addition to urine and stool tests and a measure of your head’s circumference, a doctor may do any of these diagnostic tests: […] X-ray uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. […] Magnetic resonance imaging, also called an MRI, uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. […] Computerized tomography scan, also called a CT or CAT scan, uses a combination of X-rays and computer technology to show detailed images of any part of the body, including the bones, muscles, fat, and organs.

• #70 Abscess of the Brain – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/brain-infections/abscess-of-the-brain

  A brain abscess is a pocket of pus in the brain. […] Imaging of the head is required. […] If doctors suspect a brain abscess, magnetic resonance imaging (MRI) is done before and after gadolinium is injected intravenously. Gadolinium (an MRI contrast agent) makes abscesses easier to see on MRI scans. If MRI is unavailable, computed tomography (CT) can be done after a radiopaque contrast agent (which makes abscesses easier to see on CT scans) is injected intravenously. MRI has higher resolution and can show early abnormalities better than CT. However, additional tests may be needed to establish the diagnosis because a brain tumor or damage due to a stroke or multiple sclerosis can resemble a brain abscess. […] To identify the causative organism and thus determine which medications would be most effective, doctors withdraw a sample of pus from the abscess with a needle. It is examined under a microscope and sent to a laboratory to grow (culture) bacteria in the fluid so that they can be identified. MRI or CT is used to guide the needle into the abscess. […] However, doctors do not wait to get the result of culture to start treatment.

• #71 Brain abscess – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/brain-abscess/

  Brain abscess is a focal suppurative process of the brain parenchyma. […] Brain imaging studies should be performed. Magnetic resonance imaging (MRI) with gadolinium contrast is more sensitive and specific than computed tomography (CT) with contrast. […] The diagnosis of brain abscess can be challenging in patients in whom a single ring-enhancing lesion with perifocal edema has been identified on CT, giving rise to the differential diagnosis of abscess versus necrotic tumor (glioblastoma) or metastasis. […] Once a diagnosis of brain abscess is considered after radiographic imaging, microbiologic diagnosis should be performed, including processing the samples for Gram stain and other stains if indicated (stain for fungal organisms and acid-fast bacilli) as well as obtaining cultures for both aerobic and anerobic organisms.

• #72 Brain abscess differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Brain_abscess_differential_diagnosis

  Brain abscess must be differentiated from metastatic tumors, necrotic tumors, and lymphomas. […] Diagnosis of brain abscesses and necrotic tumors is often impossible without conventional MR imaging. […] Several studies demonstrate the utility of Diffusion-weighted imaging (DWI) to differentiate between necrotic or cystic lesions and brain abscesses. […] DWI has a sensitivity and specificity of over 90% for distinguishing abscess (low ADC) from necrotic tumors (high ADC). […] Despite these differences, the true diagnosis is sometimes not made until biopsy. […] Contrast enhanced MRI is more sensitive and specific. […] MRI: Diffusion-weighted imaging (DWI) MRI can differentiate brain abscesses from cystic brain lesions with sensitivity and specificity of 96%.

• #73 Brain Abscess – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/brain-infections/brain-abscess

  Diagnosis is by contrast-enhanced MRI or CT. […] When symptoms suggest an abscess, contrast-enhanced MRI with diffusion-weighted images or, if MRI is unavailable, contrast-enhanced CT is done. A fully developed abscess appears as an edematous mass with ring enhancement, which may be difficult to distinguish from a brain tumor or occasionally infarction; CT-guided aspiration, culture, surgical excision, or a combination may be necessary. […] Culturing pus aspirated from the abscess can make targeted antibiotic therapy of the abscess possible. However, antibiotics should not be withheld until culture results are available. […] Do contrast-enhanced MRI or, if MRI is unavailable, contrast-enhanced CT. […] Treat all brain abscesses with antibiotics (usually initially with ceftriaxone or cefotaxime plus metronidazole if clinicians suspect Bacteroides species or plus vancomycin if they suspect S. aureus), typically followed by CT-guided stereotactic aspiration or surgical drainage.

• #74 Brain abscess – Wikipedia

  https://en.wikipedia.org/wiki/Brain_abscess

  Lumbar puncture procedure, which is performed in many infectious disorders of the central nervous system is contraindicated in this condition (as it is in all space-occupying lesions of the brain) because removing a certain portion of the cerebrospinal fluid may alter the concrete intracranial pressure balances and causes the brain tissue to move across structures within the skull (brain herniation). […] Ring enhancement may also be observed in cerebral hemorrhages (bleeding) and some brain tumors. However, in the presence of the rapidly progressive course with fever, focal neurologic findings (hemiparesis, aphasia etc.) and signs of increased intracranial pressure, the most likely diagnosis should be the brain abscess.

• #75 Abscess of the Brain – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/brain-infections/abscess-of-the-brain

  A brain abscess is a pocket of pus in the brain. […] Imaging of the head is required. […] If doctors suspect a brain abscess, magnetic resonance imaging (MRI) is done before and after gadolinium is injected intravenously. Gadolinium (an MRI contrast agent) makes abscesses easier to see on MRI scans. If MRI is unavailable, computed tomography (CT) can be done after a radiopaque contrast agent (which makes abscesses easier to see on CT scans) is injected intravenously. MRI has higher resolution and can show early abnormalities better than CT. However, additional tests may be needed to establish the diagnosis because a brain tumor or damage due to a stroke or multiple sclerosis can resemble a brain abscess. […] To identify the causative organism and thus determine which medications would be most effective, doctors withdraw a sample of pus from the abscess with a needle. It is examined under a microscope and sent to a laboratory to grow (culture) bacteria in the fluid so that they can be identified. MRI or CT is used to guide the needle into the abscess. […] However, doctors do not wait to get the result of culture to start treatment.

• #76 BRAIN ABSCESS | Harrison’s Manual of Medicine

  https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623483/all/BRAIN_ABSCESS

  A focal, suppurative infection within the brain parenchyma, typically surrounded by a vascularized capsule. […] Predisposing conditions include otitis media and mastoiditis, paranasal sinusitis, pyogenic infections in the chest or other body sites, head trauma, neurosurgical procedures, and dental infections. […] Many brain abscesses occur in immunocompromised hosts and are caused less often by bacteria than by fungi and parasites including Toxoplasma gondii, Aspergillus spp., Nocardia spp., Candida spp., and Cryptococcus neoformans. […] In Latin America, the most common cause of brain abscess is Taenia solium (neurocysticercosis). […] In India and the Far East, mycobacterial infection (tuberculoma) remains a major cause of focal CNS mass lesions.

• #77 European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37648062/

  These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. […] Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). […] Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). […] Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low).

• #78 European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37648062/

  These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. […] Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). […] Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). […] Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low).

• #79 Brain Abscess: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/brain-abscess

  Your provider may consider surgery if: The abscess is bigger than 2 centimeters. You have increased pressure on your brain that gets worse. […] Quick treatment at the first sign of a brain abscess can lead to a better outcome. Brain abscesses are deadly if left untreated. […] An early diagnosis and treatment lead to an improved survival rate.

• #80 Brain abscess – Overview of Information and Clinical Research

  https://clinicaltrials.eu/disease/brain-abscess/

  A brain abscess is a life-threatening condition that demands immediate medical intervention. […] The importance of early diagnosis and the factors influencing prognosis are also discussed, emphasizing the need for timely and effective management. […] Early diagnosis and treatment are crucial for improving survival rates and reducing the risk of long-term complications. Quick intervention at the first sign of a brain abscess can significantly enhance outcomes and prevent the condition from becoming life-threatening. […] Early diagnosis and treatment are critical in improving survival rates and reducing the risk of permanent brain damage. The use of advanced imaging techniques, such as CT and MRI scans, has become routine in detecting brain abscesses, contributing to the decline in mortality rates.

• #81 Brain Abscess: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/781021-workup

  Hematogenous spread is associated with cyanotic heart disease (mostly in children), pulmonary arteriovenous malformations, endocarditis, chronic lung infections (eg, abscess, empyema, bronchiectasis), skin infections, abdominal and pelvic infections, neutropenia, transplantation, esophageal dilatation, injection drug use, and HIV infection. […] The frequency of fungal brain abscess has increased because of the frequent administration of broad-spectrum antimicrobials, immunosuppressive agents, and corticosteroids. […] With the introduction of antimicrobics and the increasing availability of imaging studies, such as CT scanning and MRI, the mortality rate has decreased to less than 5%-15%. […] The frequency of neurologic sequelae in persons who survive the infection varies from 20%-79% and is predicated on how quickly the diagnosis is reached and antibiotics administered. […] Brain abscess occurs more frequently in the first 4 decades of life.

• #82

  https://journals.lww.com/co-infectiousdiseases/fulltext/2017/02000/epidemiology,_diagnosis,_and_treatment_of_brain.18.aspx

  This article describes the epidemiology, diagnosis, and treatment of brain abscesses focusing on studies published in the past 2 years. […] Our understanding of brain abscesses has increased by meta-analysis on clinical characteristics, ancillary investigations, and treatment modalities. […] Prognosis has improved over time, likely due to improved brain imaging techniques, minimally invasive neurosurgical procedures, and protocoled antibiotic treatment.

• #83 Pyogenic brain abscess, a 15 year survey | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-12-332

  The significant delays observed in timely diagnosis and treatment were caused by both doctors delay (delay or misinterpretation of neuro-imaging, referral and definitive surgery) and technical delays (caused by inadequate initial choice of imaging, e.g. CT without contrast). […] Despite diagnostic advancements with the introduction of CT and later MRI, as well as better antimicrobial agents and neurosurgical procedures, brain abscess continues to be a serious, potentially life threatening condition. Mortality continues to be relatively high. In our study almost a quarter of patients had a poor outcome. […] Key determinants of poor outcome are decreased GCS at admission, the presence of comorbidities and intraventricular rupture of brain abscess.

• #84 Clinical characteristics and outcome of primary brain abscess: a retrospective analysis | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06947-2

  Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. […] We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. […] Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. […] Good outcomes were achieved in 75.44% of the patients. […] Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.11432.407, p=0.037). […] Only a few patients showed the classical triad of clinical symptoms. […] Positive intracranial specimens culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. […] The presence of headache may influence the outcome.

• #85 Pyogenic brain abscess, a 15 year survey | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-12-332

  The significant delays observed in timely diagnosis and treatment were caused by both doctors delay (delay or misinterpretation of neuro-imaging, referral and definitive surgery) and technical delays (caused by inadequate initial choice of imaging, e.g. CT without contrast). […] Despite diagnostic advancements with the introduction of CT and later MRI, as well as better antimicrobial agents and neurosurgical procedures, brain abscess continues to be a serious, potentially life threatening condition. Mortality continues to be relatively high. In our study almost a quarter of patients had a poor outcome. […] Key determinants of poor outcome are decreased GCS at admission, the presence of comorbidities and intraventricular rupture of brain abscess.

Zobacz więcej