Brain abscess

Clinical manifestations
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By John E Greenlee MD

The classical clinical triad of brain abscess, fever, headache, and focal neurologic signs, occurs in only a minority of patients (Loeser and Scheinberg 1957; Fritz and Nelson 1997; Kastenbauer et al 2004; Helweg-Larsen et al 2012; Brouwer et al 2014a; Brouwer et al 2014b). In most cases, brain abscess presents as a rapidly or subacutely developing space-occupying lesion, and fever or other signs of active infection may be absent (Kastenbauer et al 2004; Helweg-Larsen et al 2012; Brouwer et al 2014a; Brouwer et al 2014b). Approximately 75% of patients will present with symptoms of less than 2 weeks’ duration (Fritz and Nelson 1997; Kastenbauer et al 2004; Helweg-Larsen et al 2012; Brouwer et al 2014a; Brouwer et al 2014b). Clinical signs, however, may develop so rapidly as to suggest cerebral infarction or acute meningitis, or they may evolve over weeks or even months to suggest the presence of an intracranial neoplasm (Loeser and Scheinberg 1957; Schliamser et al 1988; Shintani et al 1996). Headache occurs in approximately 75% of patients, and nausea and vomiting in about 50% of cases (Fritz and Nelson 1997; Kastenbauer et al 2004; Helweg-Larsen et al 2012; Brouwer et al 2014a; Brouwer et al 2014b). Fever is present in less than 50% of patients and may be attributed to coexisting sinusitis, otitis, or systemic infection. Focal neurologic signs are present in less than 50% of patients and, even when present, may be extremely subtle (Fritz and Nelson 1997; Kastenbauer et al 2004; Brouwer et al 2014a; Brouwer et al 2014b). Approximately one third of patients present with seizures that are most frequently generalized and are most closely associated with frontal lobe abscesses (Jadavji et al 1985; Chun et al 1986; Saez-Llorens et al 1989). Nuchal rigidity is present in about 25% of patients. Papilledema is present in no more than 25% of patients and is frequently absent in rapidly developing abscesses (Fritz and Nelson 1997; Kastenbauer et al 2004). Ventricular rupture may be manifested by severe headache and developing signs of meningeal irritation, and rapid deterioration in clinical course (Takeshita et al 2001; Helweg-Larsen et al 2012).

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors