Brain abscess

Alternative Names

Treatment

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

Medication, not surgery, is recommended if you have:

• Several abscesses (rare)
• A small abscess (less than 2 cm)
• An abscess deep within the brain
• An abscess and meningitis
• Shunts in the brain for hydrocephalus
• An underlying disease that makes surgery dangerous

Antibiotics will be given. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are most commonly used. You may be prescribed several different types of antibiotics to make sure treatment works.

Anti-fungal medications may also be prescribed if the infection is likely caused by a fungus.

An abscess that is injuring brain tissue by pressing on it or a large abscess with a high degree of swelling around it can raise intracranial pressure to the point where immediate treatment is needed.

Surgery is needed if :

• Pressure in the brain continues or gets worse
• The size of the brain abscess does not decrease after medication
• The brain abscess contains gas (produced by some types of bacteria)
• The brain abscess might rupture

Surgery consists of opening and draining the abscess. Laboratory tests are often done to examine the fluid. This can help identify the infection-causing organism so that more appropriate antibiotics or anti-fungals can be prescribed. The specific surgical procedure depends on the size and depth of the abscess. The entire abscess may be removed (excised) if it is near the surface and enclosed in a sac.

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

Certain diuretics and steroids may also be used to reduce swelling of the brain.

Outlook (Prognosis)

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

Some patients may have long-term neurological problems after surgery.

Possible Complications

• Meningitis, severe and life threatening
• Epilepsy
• Permanent neurologic losses (vision, speech, movement)
• Recurrence of infection

When to Contact a Medical Professional

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