Tasty Morsels of EM 028 – Brain Abscess

10 Mar
  • about 2% as common as brain tumours are but can look similar. More likely it’s a tumour not an abscess
  • 2:1 male:female
  • about 35% contiguous spread from craniofacial sites (think ears and sinuses)
    • about 90% of cerebellar abscesses are otic in orgin
  • about 25% post-trauma/surgical
  • about 25% haematogenous (think valves/lung abscess)
    • haematogenous spread usually in MCA distribution which makes sense given the anatomy and the flow
  • the rest (about 15%) have no obvious cause
  • >50% mixed flora; lots of anaerobes
  • fever in <50%
  • headache earliest symptom
  • focal signs and ataxia common (just like tumours)
  • seizures in 30%
Go forth and diagnose…

Reference:

Harwood-Nuss Clinical Practice of Emergency Medicine, 5th Ed, LWW 2010 p888

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