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Intracranial abscesses 

Intracranial abscesses

Intracranial abscesses

T P Lawrence

and R S C Kerr

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date: 29 April 2017

The incidence of intracranial abscess is low in countries where antimicrobial treatment for infections is widespread (e.g. 2–3 per million in the United Kingdom), but they remain frequent causes of space-occupying masses in developing countries.

Aetiology—abscesses may be classified by (1) Route of transmission, including (a) direct—from a local source of infection, e.g. otitis media; (b) haematogenous—from a distant source, e.g. endocarditis, bronchiectasis, other septic lung conditions; or (c) following cranial surgery or fracture. (2) Microbiology—the commonest organisms are aerobic, anaerobic and micro-aerophilic streptococci, Staphylococcus aureus, and bacteroides, but up to 25% of abscesses are sterile. Immunodeficient patients are at increased risk.

Clinical features and investigation—typical presentations include headache, focal neurological symptoms/signs, seizures, meningism/meningitis, and signs of raised intracranial pressure. The investigations of choice are either CT scanning, with and without contrast, or MRI. Confirmation of diagnosis, usually by culture, follows aspiration/excision.

Treatment and prognosis—aside from supportive care and (where possible) identification and treatment of any underlying cause, treatment requires (1) abscess drainage by stereotactic surgical aspiration or excision by craniotomy, and (2) long-term antimicrobial therapy. Early intervention offers the best chance of recovery: without intervention, intracranial abscesses are fatal; appropriate treatment reduces overall mortality to about 10%, but long-term complications from neurological deficit and epilepsy remain frequent in survivors.

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