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​Brain Abscess

A brain abscess is an infection in the brain tissue. The infection creates a bubble of fluid called pus, a collection of white blood cells and bodily fluids. Brain abscesses can rupture, a potentially deadly issue.

The most common cause of a brain abscess is an infection elsewhere in the body. Brain abscesses are more common in people with weakened immune systems. Doctors treat them with medication and surgery.

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What Is a Brain Abscess?

A brain abscess is an infection inside the brain that creates a bubble of pus. The abscess causes swelling that can cut off blood supply to parts of the brain.

A brain abscess is a severe and life-threatening condition. Ruptured abscesses have a high potential to cause death. Brain abscesses can also lead to brain damage or other issues, including seizures or infections in the brain's protective membranes.

What causes brain abscesses?

Brain abscesses form when germs reach the brain, from an infection in the blood to spread from dental, ear, or sinus infections or other preexisting infection. Germs — including fungi, viruses, or bacteria — can cause an abscess if they spread to the brain from elsewhere in the body.

Heart and lung infections are among the most common causes of brain abscesses. Sinus, dental, and ear infections may also lead to brain abscesses.

What are brain abscess risk factors and complications?

Brain abscess risk factors

People who are the most at risk of having a brain abscess have:

  • Weakened immune systems (older age, diabetes mellitus, etc.).
  • A chronic disease.
  • A suppressed immune system from drugs, like those prescribed after an organ transplant or cancer treatment.
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What Are the Signs and Symptoms of a Brain Abscess?

Symptoms of a brain abscess can come on suddenly or slowly. They may show up over several weeks, gradually getting worse.

Brain abscess symptoms may include:

  • Headache.
  • Vomiting.
  • Fever.
  • Confusion and general changes in mental state, including the inability to focus.
  • Vision changes.
  • Weakness and difficulty with muscle function.
  • Seizures.
  • Decreased sensation.
  • Trouble speaking.
  • Stroke-like symptoms.

Symptoms of brain abscess in babies and young children include high-pitched cries and poor feeding. The soft spot on the top of a baby's head, called the fontanel, may look full or bulge out.

Signs that the brain abscess has ruptured include:

  • Sudden onset of a worsening headache.
  • Rigidity in the neck muscles.
  • Intolerance of bright light.

When should I see a doctor about my brain abscess symptoms?

If you think you may have a brain abscess see a doctor as soon as possible. Getting prompt treatment may require going to an emergency room or calling 911. The earlier you get treatment, the better.

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How Do You Diagnose Brain Abscesses?

To diagnose a brain abscess, a doctor will do a physical exam and ask about symptoms. They'll do imaging tests to confirm a diagnosis of brain abscess. These may include a magnetic resonance imaging test (MRI) or computerized tomography (CT) scan.

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How Do You Treat a Brain Abscess?

The treatment goal for a brain abscess is to reduce pressure inside the skull and get rid of the infection. Doctors usually treat brain abscesses with a combination of medicines and surgery.

Medicine to treat a brain abscess

Doctors will give medicines called antibiotics to help fight the infection. The doctor may prescribe several different antibiotics to treat the abscess. They may start antibiotics before they confirm the abscess.

Medicine may be the only treatment if the brain abscess is:

  • Smaller than two centimeters.
  • Deep in the brain.
  • Accompanied by an infection in the lining of the brain.

Surgery for brain abscess

In addition to antibiotics, a doctor may need to do brain surgery to remove or drain the brain abscess. The doctor may recommend surgery if:

  • Antibiotics do not shrink the abscess.
  • The abscess contains gas.
  • Doctors think it may leak or burst open.
  • The abscess is bigger than two centimeters.

The surgical approach will vary depending on the location of the abscess.

What happens before and during surgery?

The UPMC neurosurgical team will do a thorough evaluation. They will choose the surgical approach that is least disruptive to the brain and critical nerves. This is often done with stereotactic image guidance, similar to using scans like MRI or CT like a GPS. Their goal during surgery is to keep the brain functioning normally.

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Recovery After Surgery for a Brain Abscess

The amount of recovery time needed after surgery varies based on:

  • The location of the abscess.
  • The type of procedure used to treat it.
  • The specific needs of the person.
  • Any health problems that happen after surgery.

Most people will remain in the hospital for at least two to five days after surgery. Doctors and nurses will monitor their recovery.

Once the doctor approves discharge, recovery will continue at home, including at least four weeks of rest. Return to everyday life will depend on progress and any lingering health issues from the abscess or surgery.

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