Synonyms:
Intracranial abscess a.k.a. intracerebral abscess:
Diagnosis:
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%
Pathology:
Biopsy:
- 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:
MRI:
- 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
MRI:
- DW: high signal, differentiates central necrosis from necrosis in tumors which is low signal.
If drained: MC&S of the aspirate
Treatment:
Antibiotics to cover appropriate organisms e.g. Penicillin G intravenous +metronidazole intravenous
Decrease edema: glucocoticoids
+/-surgical drainage