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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Usually, the features of a brain abscess develop over 2-3 weeks; occasionally, they occur more slowly; in the immunosuppressed, onset is rapid.

The typical symptoms & signs of an inflammatory reaction (pyrexia, rigors, and dehydration) are uncommon during the time of presentation (1).

Characteristically:

  • headache is usually the first symptom - it arises from raised intracranial pressure and may be accompanied by other typical features such as vomiting, drowsiness.
  • toxicity effects, e.g. fever - but its absence does not exclude the diagnosis
  • characteristics of the infective source - look for tenderness over the mastoid, sinuses; look for a discharging ear; other diagnostic signs - e.g. cardiac murmurs in SBE
  • focal neurological signs:
    • frontal abscess - impairment of memory and attention; rarely, hemiparesis +/- dysphasia and motor seizures;
    • temporal lobe - nominal dysphasia, more usual when the abscess is on the left; visual field defect - usually, a homonymous upper quadrantanopia resulting from the involvement of lower fibres of optic radiation;
    • cerebellar - headache, usually occipital; ataxia; cerebellar signs; neck stiffness

References:


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