Abstract
Brain abscess is a focal collection within the brain parenchyma, which can arise as a complication of a variety of infections, trauma or surgery. Successful treatment of a brain abscess requires a high index of suspicion and a combination of drainage and antimicrobial therapy. Empiric therapy is based on the usual microbial causes associated with the patient’s risk factors for brain abscess. As brain abscesses are frequently polymicrobial, empiric antimicrobial therapy should cover Gram-positive, Gram-negative, and anaerobic microorganisms. Once a causative microorganism is identified, antimicrobial therapy can be tailored. Expert microbiological advice is invaluable when selecting antimicrobials.
Medical management alone is considered appropriate in certain cases of brain abscess, such as small lesions (2.5–3 cm in diameter) in which the causative organism is known and if there is no compromise in neurologic status or signs of increased intracranial pressure.
Abscesses <3 cm and >1.5 cm in diameter are considered for stereotactic aspiration. Stereotactic aspiration has been shown particularly helpful in the aspiration of deep seated abscess, those in speech areas and regions of the sensory or motor cortex and in comatose patients. Excision is generally recommended for cerebellar abscesses and abscesses that are superficially located with tick membranes, posttraumatic, gas containing as well as encapsulated fungal and multiloculated abscess.
Risk factors for a poor outcome include deep seated location, intraventricular abscess rupture causing ventriculitis and a poor neurological status at admission. Many patients with neurological deficit achieve significant recovery during the rehabilitation phase.
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Nazliel, B. (2015). Brain Abscess. In: Wartenberg, K., Shukri, K., Abdelhak, T. (eds) Neurointensive Care. Springer, Cham. https://doi.org/10.1007/978-3-319-17293-4_13
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