Brain Abscess in Emergency Medicine Treatment & Management

  • Author: Lisa Elizabeth Thomas, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 13, 2010
 

Prehospital Care

Rapid transport is the key component of prehospital care for suspected intracranial abscess.

Next

Emergency Department Care

  • The initial evaluation is dictated by the severity of the patient's condition.
  • Emergent intubation using a cerebroprotective rapid sequence induction regimen is often necessary in patients with obtundation, inability to protect the airway, and suspected herniation.
  • Stable patients whose presentation suggests the diagnosis should undergo rapid neuroimaging after initial evaluation.[2, 3, 9] Close monitoring of neurologic status is essential and having at least one nurse or advanced provider in attendance while the patient is undergoing imaging is probably advisable.
  • Antibiotics should be administered as early as possible in the patient's course in the ED. These may be given prior to imaging in cases where the diagnosis is very strongly suspected.[14]
  • Seizures should be treated aggressively to decrease the risk of sustained increases in intracranial pressure. Prophylactic anticonvulsants are often used given the relatively high frequency of seizures in this population.[3]
Previous
Next

Consultations

  • Once the diagnosis is clear, immediate neurosurgical consultation is mandatory.[2, 3]
  • Infectious disease consultation may be necessary to optimize antibiotic therapy, especially in immunocompromised hosts.[2, 4]
  • Neurology consultation is helpful in guiding both immediate and long-term management.
  • Consultation with dental/oral-maxillofacial surgeons or otolaryngologists may be helpful if the primary focus of infection is odontogenic or otorhinogenic, respectively, for co-treatment and eradication of the primary source.[40, 41]
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Lisa Elizabeth Thomas, MD  Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital and Massachusetts General Hospital

Lisa Elizabeth Thomas, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Joshua N Goldstein, MD, PhD, FAAEM  Assistant Professor, Harvard Medical School; Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital

Joshua N Goldstein, MD, PhD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Stroke Association, Neurocritical Care Society, and Society for Academic Emergency Medicine

Disclosure: CSL Behring Consulting fee Consulting

Specialty Editor Board

Edward Bessman, MD  Chairman, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Barry J Sheridan, DO  Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Alderson D, Strong AJ, Ingham HR, et al. Fifteen-year review of the mortality of brain abscess. Neurosurgery. Jan 1981;8(1):1-6. [Medline].

  2. Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. Jan 2007;26(1):1-11. [Medline].

  3. Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci. Dec 2006;13(10):979-85. [Medline].

  4. Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. Oct 1997;25(4):763-79; quiz 780-1. [Medline].

  5. Sáez-Llorens X. Brain abscess in children. Semin Pediatr Infect Dis. Apr 2003;14(2):108-14. [Medline].

  6. Bernardini GL. Diagnosis and management of brain abscess and subdural empyema. Curr Neurol Neurosci Rep. Nov 2004;4(6):448-56. [Medline].

  7. Sharma R, Mohandas K, Cooke RP. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection. Feb 2009;37(1):39-43. [Medline].

  8. Menon S, Bharadwaj R, Chowdhary A, Kaundinya DV, Palande DA. Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol. Oct 2008;57(Pt 10):1259-68. [Medline].

  9. Mamelak AN, Mampalam TJ, Obana WG, et al. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery. 1995;36(1):76-85. [Medline].

  10. Yang KY, Chang WN, Ho JT, et al. Postneurosurgical nosocomial bacterial brain abscess in adults. Infection. Oct 2006;34(5):247-51. [Medline].

  11. Sennaroglu L, Sozeri B. Otogenic brain abscess: review of 41 cases. Otolaryngol Head Neck Surg. Dec 2000;123(6):751-5. [Medline].

  12. Cavusoglu H, Kaya RA, Türkmenoglu ON, Colak I, Aydin Y. Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period. Neurosurg Focus. 2008;24(6):E9. [Medline].

  13. Gallitelli M, Lepore V, Pasculli G, et al. Brain abscess: a need to screen for pulmonary arteriovenous malformations. Neuroepidemiology. 2005;24(1-2):76-8. [Medline].

  14. Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis. Sep 1992;15(3):394-401. [Medline].

  15. Vidal JE, Oliveira AC, Filho FB, et al. Tuberculous brain abscess in AIDS patients: report of three cases and literature review. Int J Infect Dis 9(4):201-7. 2005;9(4):201-7. [Medline].

  16. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. Feb 23 2010;[Medline].

  17. Kranick SM, Vinnard C, Kolson DL. Propionibacterium acnes brain abscess appearing 10 years after neurosurgery. Arch Neurol. Jun 2009;66(6):793-5. [Medline].

  18. Thomas SG, Moorthy RK, Rajshekhar V. Brain abscess in a non-penetrating traumatic intracerebral hematoma: case report and review of literature. Neurol India. Jan-Feb 2009;57(1):73-5. [Medline].

  19. Kennedy KJ, Chung KH, Bowden FJ, et al. A cluster of nocardial brain abscesses. Surg Neurol. Jul 2007;68(1):43-9; discussion 49. [Medline].

  20. Wolf J, Curtis N. Brain abscess secondary to dental braces. Pediatr Infect Dis J. Jan 2008;27(1):84-5. [Medline].

  21. Gaïni S, Grand M, Michelsen J. Brain abscess after esophageal dilatation: case report. Infection. Feb 2008;36(1):71-3. [Medline].

  22. Roberts J, Bartlett AH, Giannoni CM, et al. Airway foreign bodies and brain abscesses: report of two cases and review of the literature. Int J Pediatr Otorhinolaryngol. Feb 2008;72(2):265-9. [Medline].

  23. Katragkou A, Dotis J, Kotsiou M, et al. Scedosporium apiospermum infection after near-drowning. Mycoses. Sep 2007;50(5):412-21. [Medline].

  24. Laviv Y, Ben-Daviv U, Vated M, Rappaport ZH. Brain abscess following endoscopic ligation of esophageal varicose veins. Acta Neurochir (Wien). Apr 2010;152(4):733-4. [Medline].

  25. Herskovitz MY, Goldsher D, Finkelstein R, Bar-Lavi Y, Constantinescu M, Telman G. Multiple brain abscesses associated with tongue piercing. Arch Neurol. Oct 2009;66(10):1292. [Medline].

  26. Khouzam RN, El-Dokla AM, Menkes DL. Undiagnosed patent foramen ovale presenting as a cryptogenic brain abscess: case report and review of the literature. Heart Lung. Mar-Apr 2006;35(2):108-11. [Medline].

  27. Enany S, Higuchi W, Okubo T, et al. Brain abscess caused by Panton-Valentine leukocidin-positive community-acquired methicillin-resistant Staphylococcus aureus in Egypt, April 2007. Euro Surveill. Sep 27 2007;12(9):E070927.2. [Medline].

  28. Sifri CD, Park J, Helm GA, et al. Fatal brain abscess due to community-associated methicillin-resistant Staphylococcus aureus strain USA300. Clin Infect Dis. Nov 1 2007;45(9):e113-7. [Medline].

  29. Naesens R, Ronsyn M, Druwé P, Denis O, Ieven M, Jeurissen A. Central nervous system invasion by community-acquired meticillin-resistant Staphylococcus aureus. J Med Microbiol. Sep 2009;58(Pt 9):1247-51. [Medline].

  30. Hakan T, Ceran N, Erdem I, et al. Bacterial brain abscesses: an evaluation of 96 cases. J Infect. May 2006;52(5):359-66. [Medline].

  31. Kao PT, Tseng HK, Liu CP, et al. Brain abscess: clinical analysis of 53 cases. J Microbiol Immunol Infect. Jun 2003;36(2):129-36. [Medline].

  32. Marshman LA, Connor S, Chandler CL. Persistent absence of ring-enhancement on CT with an encapsulated brain abscess. Br J Neurosurg. Aug 2004;18(4):377-82. [Medline].

  33. Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx. Apr 2005;2(2):324-32. [Medline].

  34. Lai PH, Hsu SS, Ding SW, et al. Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol. 2007;68 Suppl 1:S25-36. [Medline].

  35. Pal D, Bhattacharyya A, Husain M, Prasad KN, Pandey CM, Gupta RK. In vivo proton MR spectroscopy evaluation of pyogenic brain abscesses: a report of 194 cases. AJNR Am J Neuroradiol. Feb 2010;31(2):360-6. [Medline].

  36. Reiche W, Schuchardt V, Hagen T, Il'yasov KA, Billmann P, Weber J. Differential diagnosis of intracranial ring enhancing cystic mass lesions--role of diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI). Clin Neurol Neurosurg. Apr 2010;112(3):218-25. [Medline].

  37. Kimberly HH, Shah S, Marill K, et al. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. Feb 2008;15(2):201-4. [Medline].

  38. Hasbun R, Abrahams J, Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. Dec 13 2001;345(24):1727-33. [Medline].

  39. Song L, Guo F, Zhang W, Sun H, Long J, Wang S. Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci. Dec 2008;29(6):425-30. [Medline].

  40. Mueller AA, Saldamli B, Stübinger S, Walter C, Flückiger U, Merlo A. Oral bacterial cultures in nontraumatic brain abscesses: results of a first-line study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. Apr 2009;107(4):469-76. [Medline].

  41. Tandon S, Beasley N, Swift AC. Changing trends in intracranial abscesses secondary to ear and sinus disease. J Laryngol Otol. Mar 2009;123(3):283-8. [Medline].

  42. Martin-Canal G, Saavedra A, Asensi JM, Suarez-Zarracina T, Rodriguez-Guardado A, Bustillo E. Meropenem monotherapy is as effective as and safer than imipenem to treat brain abscesses. Int J Antimicrob Agents. Mar 2010;35(3):301-4. [Medline].

  43. Boviatsis EJ, Kouyialis AT, Stranjalis G, et al. CT-guided stereotactic aspiration of brain abscesses. Neurosurg Rev. Jul 2003;26(3):206-9. [Medline].

  44. Hakan T. Management of bacterial brain abscesses. Neurosurg Focus. 2008;24(6):E4. [Medline].

  45. Smith SJ, Ughratdar I, MacArthur DC. Never go to sleep on undrained pus: a retrospective review of surgery for intraparenchymal cerebral abscess. Br J Neurosurg. Aug 2009;23(4):412-7. [Medline].

  46. Unal O, Sakarya ME, Kiymaz N, et al. Brain abscess drainage by use of MR fluoroscopic guidance. Am J Neuroradiol. 2005;26(4):839-42. [Medline].

  47. Kurschel S, Mohia A, Weigl V, et al. Hyperbaric oxygen therapy for the treatment of brain abscess in children. Childs Nerv Syst. 2005;May 5:[Medline].

  48. Kutlay M, Colak A, Yildiz S, et al. Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses. Neurosurgery. Dec 2005;57(6):1140-6; discussion 1140-6. [Medline].

  49. Lee TH, Chang WN, Su TM, et al. Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses. J Neurol Neurosurg Psychiatry. Mar 2007;78(3):303-9. [Medline].

  50. Xiao F, Tseng MY, Teng LJ, et al. Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol. May 2005;63(5):442-9; discussion 449-50. [Medline].

  51. Demir MK, Hakan T, Kilicoglu G, et al. Bacterial brain abscesses: prognostic value of an imaging severity index. Clin Radiol. Jun 2007;62(6):564-72. [Medline].

  52. Prasad KN, Mishra AM, Gupta D, et al. Analysis of microbial etiology and mortality in patients with brain abscess. J Infect. Oct 2006;53(4):221-7. [Medline].

 
Previous
Next
 
Brain abscess.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.