Diagnosis:
Imaging (MRI with and without contrast) plus biopsy for confirmation
Pathology:
Biopsy:
- Necrosis with inflammation (neutrophils & later macrophages & lymphocytes), rim of fibrosis (if absent this is cerebritis)
- Surrounding gliosis
Clinical features:
- Intracranial: focal neurological deficit
- Spinal: transverse myelopathy and a flexed posture resisting extension, back pain with fever.
Investigations to consider:
FBC, ESR, CRP
Blood cultures
LP for CSF:
- Pleocytosis & increased protein
- NB. Not at the site of abscess
- Gram stain & culture of excised material
MRI, gadolinium enhanced
Consider myelography
Treatment:
Neurological emergency
Surgery, not done in some cases in absence of compression
Antibiotics:
- Naficillin or vancomycin intravenous empirically
- Same doses as meningitis