Classically the treatment is by drainage, culture and antibiotic administration.
Antibiotics:
- should be used in
- multiple abscesses
- abscesses located deep inside the brain (1)
- consult bacteriologist re: appropriate antibiotics. Blind therapy may involve ceftazidime (cover gram +ve's and gram -ve's), metronidazole (cover anaerobes) and flucloxacillin (cover staphylococcus aureus)
- switch to more specific treatments once organisms identified
Abscess drainage:
- primary excision of whole abscess - standard for cerebellar abscess; risk of damage to surrounding brain tissue
- burr hole aspiration - simple, safe, may need repeating
- open evacuation - involves craniotomy; avoids damage to surrounding brain
Treatment of primary infection site as required:
- to reduce the risk of recurrence
- surgical treatment - sinus or middle ear infection; cardiac surgery for infective valves
- physiotherapy and antibiotics - for pulmonary infection
Steroids may reduce oedema but reduce antibiotic penetration.
Prophylactic anticonvulsants - around 40-50% of patients with an intracranial abscess develops seizures. (2)
References:
- 1. Morgan R. Picture Quiz: Cerebral abscess. StudentBMJ 2003;11
- 2. Whitfield P. The Management of Intracranial Abscesses. ACNR 2005; 5(1)