Last reviewed: 24 Feb 2023
Last updated: 26 Jan 2021
Summary
Definition
History and exam
Key diagnostic factors
- male sex
- age <30 years
- meningismus
- headache
- cranial nerve palsy
- positive Kernig or Brudzinski sign
- fever
- increased head circumference (infants)
- bulging fontanelles (infants)
More key diagnostic factors
Other diagnostic factors
- neurological deficit
- papilledema
Other diagnostic factors
Risk factors
- sinusitis
- otitis media
- dental procedure/infection
- meningitis
- recent neurosurgery
- congenital heart disease
- endocarditis
- diverticular disease
- hereditary hemorrhagic telangiectasia or arteriovenous malformation
- diabetes mellitus
- HIV or immunocompromise
- intravenous drug use
- chronic granulomatous disease
- hemodialysis
- birth prematurity
- cystic fibrosis
More risk factors
Diagnostic investigations
1st investigations to order
- CBC
- serum erythrocyte sedimentation rate (ESR)
- serum CRP
- serum PT and PTT
- blood culture
- serum toxoplasma titer
- MRI with contrast
- CT head with and without contrast
- ultrasound head (infants)
More 1st investigations to order
Investigations to consider
- magnetic resonance spectroscopy (MRS)
- lumbar puncture (LP) with cerebrospinal fluid (CSF) analysis
- CT chest, abdomen, and pelvis
- bone scan
- mammogram
More investigations to consider
Treatment algorithm
INITIAL
presumed brain abscess
ACUTE
suspected or confirmed bacterial etiology
confirmed fungal etiology
suspected or confirmed parasitic etiology
cryptogenic brain abscess
Contributors
Authors
Walter A. Hall, MD, MBA
Professor
Department of Neurosurgery
SUNY Upstate Medical University
Syracuse
NY
Disclosures
WAH is an author of a number of references cited in this topic.
Acknowledgements
Dr Walter A. Hall would like to gratefully acknowledge Dr Peter D. Kim, a previous contributor to this topic. PDK declares that he has no competing interests.
Peer reviewers
Stephen Haines, MD
Professor and Head
Department of Neurosurgery
University of Minnesota
Minneapolis
MN
Disclosures
SH and WAH were colleagues on a faculty of the University of Minnesota between 1991 and 1997 and again between 2004 and 2006. They have coauthored articles on neurosurgical infection.
Sabrina Ravaglia, MD, PhD
Staff Physician
Department of Neurological Sciences
Institute of Neurology C. Mondino
Pavia
Italy
Disclosures
SR declares that she has no competing interests.
Differentials
- Primary central nervous system neoplasm
- Metastatic lesion
- Recurrent tumor/radiation necrosis in a postsurgical patient
More Differentials
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer