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Condition/Disorder Synonym

  • Cerebral abscess

ICD-9-CM Codes

  • 324.0 Intracranial abscess

ICD-10-CM Codes

  • G06.0 Intracranial abscess and granuloma
  • G06.2 Extradural and subdural abscess, unspecified

Preferred Practice Patterns1

Key Features

Description

  • Confined area of infection within the cranium

Essentials of Diagnosis

  • Greater than 90% of brain abscesses due to external causes: compound fracture of skull, bullet wound, surgical complication involving brain or cranium
  • May be secondary to infectious process elsewhere in the body including
    • Paranasal sinus (rhinogenic): usually leads to abscess in frontal and temporal lobes
    • Middle ear (otogenic): usually leads to abscess in anterolateral cerebellum, middle and inferior temporal lobe
    • Pulmonary infection
    • Bacterial endocarditis
  • Rupture of abscess can advance to irreversible coma

General Considerations

  • Approximately 50% are metastatic
  • Approximately 20% cannot be traced to site of origin

Demographics

  • All ages and genders, who experience one of the contributing causes, are at risk for developing a brain abscess
  • 60% of children who develop a brain abscess have congenital heart disease

Clinical Findings

Signs and Symptoms

  • Headache
  • Drowsiness
  • Confusion
  • Focal or generalized seizure
  • Focal motor, sensory, or speech disturbance
  • Fever (inconsistent)
  • Leukocytosis (inconsistent)
  • Increased intracranial pressure (later in the course of illness)
  • Papilledema (later in the course of illness)

Functional Implications

  • Loss of independence with all aspects of mobility, ADLs, self-care
  • Impaired ability to interact with others effectively
  • Difficulty with cognitive processing, particularly executive function

Possible Contributing Causes

  • Bacterial endocarditis
  • Pulmonary infection
  • Sinus infection
  • Middle-ear infection
  • Congenital heart disease
  • Infected pelvic organs
  • Infected tonsils
  • Abscessed teeth
  • Osteomyelitis
  • Pulmonary ateriovenous malformation
  • Surgical trauma
  • Cranial injury

Differential Diagnosis

Means of Confirmation or Diagnosis

Laboratory Tests

  • Sedimentation rate
  • Cerebrospinal fluid (CSF) pressure
  • Mild to moderate pleocytosis
  • Complete blood count (CBC)

Imaging

Findings and Interpretation

  • Blood protein moderately elevated
  • Elevated sedimentation rate
  • Moderately increased cerebrospinal fluid (CSF) pressure

Treatment

Medication

  • Antibiotics, usually intravenous, for several weeks
  • Intravenous Mannitol or dexamethasone to prevent cerebellar herniation and temporal-lobe damage

Referrals/Admittance

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