(Infection)

Overview

• A suppurative collection of microbes (often bacterial, fungal or parasitic) within a gliotic capsule occuring within the brain parenchyma
• Aeitology → spread of an infection (otitis media, sinusitis, dental infection, meningitis, endocarditis etc.), trauma or surgery to the scalp, penetrating head injuries
• Have considerable mass effect on brain, raised ICP is common
• Most common pathogens → viridans streptococci (secondary to sinusitis), staphylococcus aureus
• Prevalence highest in adult men <30 yrs old, while paediatric disease most often occurs in children 4-7 yrs old

Making Diagnosis

Clinical Features:

• Features of rasied ICP → nausea, vomiting, papilloedema, seizures
• Dull persistent headache (ruptured abscess is associated with sudden worsening of headache and meningism)
• Focal Neurology → 3rd or 6th Cranial Nerve Palsy (secondary to raised ICP)
  • CN6 (abducens) is most likely to be compressed due to raised ICP as it has the longest course
  • CN 3/4/6 Palsies
• Fever
• Positive Kernig or Brudzinski sign

<aside> 💡 Headache + Fever + Focal Neurology ⇒ brain abscess

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