Learn About Brain Abscess

What is the definition of Brain Abscess?

A brain abscess is a collection of pus, immune cells, and other material in the brain, caused by a bacterial or fungal infection.

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What are the alternative names for Brain Abscess?

Abscess - brain; Cerebral abscess; CNS abscess

What are the causes of Brain Abscess?

Brain abscesses commonly occur when bacteria or fungi infect part of the brain. As a result, swelling and irritation (inflammation) develop. Infected brain cells, white blood cells, live and dead bacteria or fungi collect in an area of the brain. Tissue forms around this area and creates a mass or abscess.

The germs that cause a brain abscess can reach the brain through the blood. Or, they enter the brain directly, such as during brain surgery. In some cases, a brain abscess develops from an infection in the sinuses.

The source of the infection is often not found. However, the most common source is a lung infection. Less often, a heart infection is the cause.

The following raise your chance of developing a brain abscess:

  • A weakened immune system (such as in people with HIV/AIDS)
  • Chronic disease, such as cancer
  • Drugs that suppress the immune system (corticosteroids or chemotherapy)
  • Congenital heart disease
What are the symptoms of Brain Abscess?

Symptoms may develop slowly, over a period of several weeks, or they may develop suddenly. They may include:

  • Changes in mental status, such as confusion, slow response or thinking, unable to focus, or sleepiness
  • Decreased ability to feel sensation
  • Fever and chills
  • Headache, seizures, or stiff neck
  • Language problems
  • Loss of muscle function, typically on one side
  • Vision changes
  • Vomiting
  • Weakness
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What are the current treatments for Brain Abscess?

A brain abscess is a medical emergency. Pressure inside the skull may become high enough to be life threatening. You will need to stay in the hospital until the condition is stable. Some people may need life support.

Medicine, not surgery, is recommended if you have:

  • A small abscess (less than 2 cm)
  • An abscess deep in the brain
  • An abscess and meningitis
  • Several abscesses (rare)
  • Shunts in the brain for hydrocephalus (in some cases, the shunt may need to be removed temporarily or replaced)
  • An infection called toxoplasmosis in a person with HIV/AIDS

You may be prescribed several different types of antibiotics to make sure treatment works.

Antifungal medicines may also be prescribed if the infection is likely caused by a fungus.

Surgery is needed if:

  • Increased pressure in the brain continues or gets worse
  • The brain abscess does not get smaller after medicine
  • The brain abscess contains gas (produced by some types of bacteria)
  • The brain abscess might break open (rupture)
  • The brain abscess is large (more than 2 cm)

Surgery consists of opening the skull, exposing the brain, and draining the abscess. Laboratory tests are often done to examine the fluid. This helps identify the cause of the infection, so that the right antibiotics or antifungal medicine can be prescribed.

Needle aspiration guided by CT or MRI scan may be needed for a deep abscess. During this procedure, medicines may be injected directly into the mass.

Certain diuretics (medicines that reduce fluid in the body, also called water pills) and steroids may also be used to reduce the swelling of the brain.

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What is the outlook (prognosis) for Brain Abscess?

If untreated, a brain abscess is almost always deadly. With treatment, the death rate is about 10% to 30%. The earlier treatment is received, the better.

Some people may have long-term nervous system problems after surgery.

What are the possible complications of Brain Abscess?

Complications may include:

  • Brain damage
  • Meningitis that is severe and life threatening
  • Return (recurrence) of infection
  • Seizures
When should I contact a medical professional for Brain Abscess?

Go to a hospital emergency room or call the local emergency number (such as 911) if you have symptoms of a brain abscess.

How do I prevent Brain Abscess?

You can reduce the risk of developing a brain abscess by getting treated for infections or health problems that can cause them.

Some people, including those with certain heart disorders, may receive antibiotics before dental or other procedures to help reduce the risk of infection.

Amebic brain abscess
What are the latest Brain Abscess Clinical Trials?
Adjunctive Dexamethasone for Cerebral Toxoplasmosis: a Double-blinded Randomized Controlled Trial

Summary: Toxoplasma gondii infects over one third of the global human population. Cerebral toxoplasmosis is the most common opportunistic infection in HIV patients resulting in up to 50% of mortality with proper treatment and 80% without it. The fatality mainly due to the brain edema resulted from the mass effect lesion. In addition of anti toxoplasmosis given, adjunctive therapy such as steroid is recomme...

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Partial Oral Antibiotic Treatment for Bacterial Brain Abscess: An Open-label Randomised Non-inferiority Trial

Summary: The investigators aim to determine if oral antibiotics are clinically acceptable as treatment of brain abscess. Following 2 weeks of standard intravenous antibiotic therapy, half of patients will continue with this treatment for another 4 weeks or longer while the other half will be assigned to oral antibiotics for the remaining duration of treatment.

What are the Latest Advances for Brain Abscess?
Osler's disease - a disease with a wide variety of clinical manifestations deserving multidisciplinary competence.
Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis.
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Aspiration Surgery with Appropriate Antibiotic Treatment Yields Favorable Outcomes for Bacterial Brain Abscess.
Who are the sources who wrote this article ?

Published Date: December 24, 2020
Published By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Gea-Banacloche JC, Tunkel AR. Brain abscess. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 90.

Nath A, Berger JR. Brain abscess and parameningeal infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 385.