Brain Abscess


Intracranial abscess a.k.a. intracerebral abscess:


Suggested by imaigng. Confirmed by biopsy and culture

Clinical features:

  • Presents with focal neurological deficits: weakness, aphasia, neglect
  • May present with headache or seizure
  • Meningismus in <30%



  • Necrosis with inflammation (neutrophils & later macrophages & lymphocytes), rim of fibrosis (if absent this is cerebritis)
  • Surrounding gliosis
  • See fungal section for further details
  • Toxoplasma gondii section for further details

Findings on Investigations:


  • Smooth walled, usually thin walled lesion at grey-white interface
  • Surrounding edema
  • Enhances with contrast, ring. Meningeal enhancement may occur
  • DWI: may be bright as opposed to neoplasms

Investigations to consider:

Complete blood count
CT noncontrast & contrast, or MRI:

  • Lesion with enhanced rim a.k.a. ring enhancing lesion
  • +surrounding edema
  • +smooth capsule


  • DW: high signal, differentiates central necrosis from necrosis in tumors which is low signal.

If drained: MC&S of the aspirate


Antibiotics to cover appropriate organisms e.g. Penicillin G intravenous +metronidazole intravenous
Decrease edema: glucocoticoids
+/-surgical drainage

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