Brain and Spinal Abscesses

Brain and spinal abscesses are often devastating infections that can lead to substantial morbidity and mortality if not recognized and treated in a timely manner. The clinical presentation depends upon the route of spread of infection to the central nervous system, location of the lesion, and severity of increased intracranial pressure. Brain abscess is defined as a focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus that is surrounded by a vascularized capsule; patients most often develop brain abscess by contiguous spread, hematogenous dissemination, or trauma. This chapter discusses the epidemiology, etiology, pathogenesis, diagnosis, management, and prognosis for brain abscess. Also examined are epidemiology and pathogenesis, etiology, diagnosis, management, and prognosis for both cranial subdural empyema and epidural abscess and spinal epidural abscess and subdural empyema. Tables list predisposing conditions and likely etiologic agents in brain abscess; histopathologic findings in the stages of brain abscess formation; presenting symptoms and signs in patients with brain abscess; antimicrobial therapy of brain abscess based on isolated pathogen; predisposing conditions and empirical antimicrobial therapy in patients with presumed bacterial brain abscess; recommended dosages of antimicrobial agents in adults with brain abscess; and normal renal and hepatic function. Figures in this chapter are images of intra-axial fluid collection; a subdural fluid collection; a ring-enhancing subdural empyema; an epidural abscess; a large epidural fluid collection with midline shift; a dorsal epidural collection; and loculated ring enhancement suggesting an epidural abscess. This chapter contains 6 highly rendered figures, 6 tables, 167 references, 5 MCQs.