Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- sexo masculino
- idade <30 anos
- meningismo
- cefaleia
- paralisia do nervo craniano
- sinal de Kernig ou Brudzinski positivo
- febre
- perímetro cefálico aumentado (bebês)
- fontanela abaulada (bebês)
Other diagnostic factors
- deficit neurológico
- papiledema
Risk factors
- sinusite
- otite média
- procedimento odontológico/infecção dentária
- meningite
- cirurgia de cabeça e pescoço ou neurocirurgia recente
- cardiopatia congênita
- endocardite
- doença diverticular
- telangiectasia hemorrágica hereditária ou malformação arteriovenosa
- diabetes mellitus
- vírus da imunodeficiência humana (HIV) ou imunocomprometimento
- uso de substâncias por via intravenosa
- doença granulomatosa crônica
- hemodiálise
- nascimento prematuro
- fibrose cística
Diagnostic investigations
1st investigations to order
- Hemograma completo
- velocidade de hemossedimentação (VHS) sérica
- proteína C-reativa sérica
- tempo de protrombina (TP), tempo de tromboplastina parcial (TTP) e razão normalizada internacional (INR) séricos
- hemocultura
- ressonância nuclear magnética (RNM) com contraste
- tomografia computadorizada (TC) de crânio com e sem contraste
- ultrassonografia do crânio (bebês)
Investigations to consider
- sorologia para toxoplasma
- espectroscopia por ressonância magnética
- punção lombar (PL) e análise do líquido cefalorraquidiano (LCR)
- TC de tórax, abdome e pelve
- cintilografia óssea
- mamografia
Treatment algorithm
abscesso cerebral presumido
etiologia bacteriana confirmada ou suspeita
etiologia fúngica confirmada
etiologia parasitária confirmada ou suspeita
abscesso cerebral criptogênico
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.
Revisores
Stephen Haines, MD
Professor and Head
Department of Neurosurgery
University of Minnesota
Minneapolis
MN
Declarações
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014 Mar 4;82(9):806-13. Abstract
Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurgery. 2008 Feb;62(2 suppl):519-30. Abstract
Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics. 2004 Jun;113(6):1765-70. Abstract
Expert Panel on Neurologic Imaging; Whitehead MT, Cardenas AM, et al. ACR Appropriateness Criteria® headache. J Am Coll Radiol. 2019 Nov;16(11s):S364-77.Full text Abstract
American College of Radiology. ACR-ASNR-SPR practice parameter for the performance and interpretation of magnetic resonance spectroscopy of the central nervous system. 2019 [internet publication].Full text
Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. The rational use of antibiotics in the treatment of brain abscess. Br J Neurosurg. 2000 Dec;14(6):525-30. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Diferenciales
- Neoplasia primária do sistema nervoso central
- Lesão metastática
- Tumor recorrente/necrose por radiação em um paciente pós-cirúrgico
Más DiferencialesGuías de práctica clínica
- Anaerobic infections (individual fields): central nervous system infections (brain abscess, subdural abscess, epidural abscess and bacterial meningitis)
Más Guías de práctica clínica
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