image by: HWN

HWN Suggests

Don't Pick Your Brain

Diagnosing a brain abscess can be difficult as the physical exam findings and symptoms are variable, nonspecific, and are often delayed in presentation. The most common symptom is headache and the classic triad of headache, fever, and focal neurologic deficit is only present in about 20% of cases. While magnetic resonance imaging (MRI) is the preferred imaging modality for early and accurate diagnosis of brain abscesses, this is frequently not the best first choice in emergent situations due to the time and cost. Computerized tomography (CT) with iodinated contrast provides a more rapid and cost-effective approach in evaluating for brain abscess in the ED, but is not as sensitive as MRI. In addition…

read full article

Featured

 Brain abscess: an antediluvian affliction of the past?

The first documented description of a brain abscess is attributed to Hippocrates as early as 460 B.C. In his Book of Prognostics, Hippocrates noted, “acute pain in the ear with continual and strong fever is to be dreaded; for there is danger that the man may become delirious and die . . . only if white matter run from the ear, there may be hope that a younger person may recover”. From these astute observations Hippocrates elucidated that brain abscesses were inevitably fatal if not treated and that drainage of its contents offered hope of a cure. In fact, in his Corpus Hippocraticum, surgical drainage was advised: “incise the head at the bregma, bore right through to the brain and heal the wound as one would by sewing”.

 Brain-Infecting Mold Detections Rose at One U.S. Lab, but 49 Cases Since 2009 Cannot Show National Risk

The report's main message is for doctors. The authors advise clinicians to "consider C. bantiana in patients who have signs and symptoms of a brain abscess." A three-drug antifungal combination given for at least two weeks has shown some effectiveness, and surgery to drain or remove the abscess was linked to better outcomes in a 2024 French study of 23 patients, Contagion Live noted.

Articles of Interest

The Management of Intracranial Abscesses

Although the incidence of intracranial abscesses has decreased over the past 100 years the surgical principles expostulated by MacEwen in 1881, namely debridement and drainage, remain of paramount importance. Advances in neuronavigation techniques make stereotactic drainage a simple procedure that can be performed expeditiously for the majority of abscesses. The appropriate use of effective antibiotic therapy adds to the therapeutic armamentarium. Surveillance imaging with MRI scans is now the follow-up modality of choice. These changes in management have seen a significant reduction in the mortality of brain abscesses in the last 20 years.

Brain Abscess Masquerading as Brain Infarction

Brain abscesses typically present with progressive headache, an altered level of consciousness, progressive focal neurologic deficits, and/or seizure. Occasionally, patients can present with sudden onset focal neurological symptoms and it can be difficult to differentiate cerebral abscess from acute ischemic stroke on clinical grounds. Differentiating these two entities based on radiological findings is usually straightforward but can sometimes be challenging as ischemic infarcts and cerebritis/early cerebral abscesses can have overlapping magnetic resonance imaging (MRI) findings in the acute setting.

Brain Abscess: A Rare Clinical Case with Oral Etiology

Brain abscess is a very rare condition but has a significant mortality rate. The three main routes of inoculation are trauma, contiguous focus, and the hematogenous route. The odontogenic focus is infrequent and is usually a diagnosis of exclusion.

Brain abscess: Current management

BA is one of the most serious diseases of the CNS. This condition is more common among men –twice to three times, and morbidity rate is highest in fourth decade of the life. BA is still associated with high morbidity, including seizures (up to 80%), persistent altered mental status, and focal motor deficits. BA still continues to be a significant problem in the developing world due to large scale poverty, illiteracy, and lack of hygiene.

Cerebral Abscess Mimicking Intracerebral Hemorrhage: A Case Report

Cerebral abscesses typically arise from the contiguous spread of pathogens in immunocompetent individuals. This occurs most frequently from local foci such as otitis media, mastoiditis, sinusitis, neurosurgical procedures, and head trauma, collectively accounting for approximately 40% to 50% of all reported cases. The pathophysiological process involves the direct extension of infection from these local foci into the central nervous system...

Dangerous brain abscesses spiked in US kids as COVID restrictions dropped

Even at the height of the unusual surge, the brain infections remained rare overall, and the latest data suggests cases are on the decline. But, the infections are serious and potentially life-threatening. They occur when bacteria, viruses, or fungi enter the brain and an encapsulated area forms around the germs and pus. Bacteria, particularly Streptococcus, appeared to be the main culprit in the recent rise.

Deadly Fungus That Causes Pus-Filled Brain Abscesses Is on the Rise in the US

Authored by: Namya Sinha Updated: Oct 15, 2026, 09:21 IST Detections of Cladophialophora bantiana rose about fourfold between 2023 and 2025, a new US study finds. Up to 70% of people infected with the rare fungus die, even with aggressive treatment.

Mapping Half a Century of Global Brain Abscess Research: A Bibliometric Analysis of Output, Themes, and Collaboration (1975–2025)

Brain abscess is an uncommon but life-threatening intracranial infection managed across neurosurgery, infectious diseases, microbiology and neuroradiology, for which no single unified international guideline exists; despite a large literature, the research field has been mapped only once...

My brain abscess and me

I had no idea I had a potentially fatal infection. Now, after my life-saving surgery, I will never take my health for granted again

The real science of brain rot

Blame cell death and fungi for brain decay, not TikTok.

What you need to know about brain abscesses

Brain abscesses are a surgical emergency and patients should be urgently referred to a neurosurgical centre after systemic stabilisation and neuroimaging.

William Macewen and the treatment of brain abscesses: revisited after one hundred years

Macewen recorded 25 cases of brain abscess. Nineteen of these patients came to his attention in time to undergo surgery, resulting in 18 recoveries. All five of his patients with extradural abscess recovered. These results were achieved in the era known as "the most glorious period in British surgery." Neurosurgery was in its infancy; nevertheless, even as the 20th century closes, Macewen's results still have not been surpassed.

Resources

EmCrit

The overall presentation is similar to that of a brain tumor, but the tempo of progression is faster, and there may be systemic inflammation. Nonetheless, this is a subacute process, with patients often presenting with symptoms lasting 1-2 weeks.

Harvard Health

Diagnosing a brain abscess can be challenging because the early symptoms are so general. For example, there are many causes of headaches that are far more common than brain abscess. For this reason, the diagnosis of brain abscess is often not made until about two weeks after symptoms first develop. In some cases, people with brain abscesses develop seizures or neurological changes, such as muscle weakness on one side of the body, before the diagnosis is made.

StatPearls

A brain abscess is a localized area of necrosis within the brain parenchyma, often resulting from infectious agents, such as Staphylococcus and Streptococcus, or trauma or surgery. In addition, infections in the head and neck may contribute to abscess development. Abscesses often arise from local infections in areas such as the ear, teeth, sinuses, mastoid air cells, or epidural spaces, but they may also originate from distant sites such as the lungs or heart. In young children, congenital heart disease can be a risk factor. Although brain abscesses can occur at any age, they are most common in the third decade of life.