Clinical Presentation

Contemporary clinical presentation of brain abscess differs negligibly from classical descriptions. Most cases occur in the first two decades, with an unexplained male predilection. Most patients present with generalized signs of elevated ICP and/or focal neurological findings that depend on the size, location and multiplicity of the lesions, virulence of the organism, host response and the severity of cerebral edema. Although the symptoms of brain abscess are largely indistinguishable from those of any other space-occupying lesion, the tempo of progression tends to be more rapid, with 75% of patients having symptoms for less than 2 weeks.However, immunocompromised patients may present more insidiously and a high index of suspicion is necessary to establish an early diagnosis [2].

Headache is prominent in 70-97% of patients, which is often constant, progressive and refractory to therapy. Nausea and vomiting due to elevated ICP occur in 25-50% of patients. Slightly over 50% of patients have a low-grade fever, but fever exceeding101.5oF is relatively unusual and may indicate a concomitant systemic infection or meningitis. Two-thirds of patients have varying degrees of altered senso-rium and more than 60% of patients demonstrate focal neurological findings. Seizures occur in 30-50% of patients prior to any surgical intervention [2,8]. Infants present with a combination of enlarging head circumference, bulging fontanel, separation of the cranial sutures, vomiting, irritability, seizures and poor feeding [5].

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