Management of Brain Abscesses and Associated Infections

Brain abscesses represent a critical focal intracranial infection, often arising from contiguous spread, haematogenous dissemination or direct trauma. Prompt recognition and comprehensive management are vital to reduce the substantial morbidity and mortality associated with these lesions. Initial assessment hinges on clinical examination combined with advanced neuroimaging to distinguish abscess from neoplasm. Diffusion‐weighted and perfusion‐weighted MRI sequences, supported by proton spectroscopy, delineate the characteristic capsule and central pus collection, guiding both medical and surgical strategies. Empirical broad‐spectrum antibiotic regimens are tailored according to likely pathogens and refined once microbiological or molecular data become available. Stereotactic aspiration via burr hole or open craniotomy facilitates decompression, microbial diagnosis and loculation breakdown, while minimising collateral neurological injury. Duration of antimicrobial therapy typically extends for six to eight weeks, with adjustment based on imaging resolution and laboratory markers. Multidisciplinary collaboration among neurosurgeons, infectious disease specialists, neuroradiologists and microbiologists underpins individualised care, antibiotic stewardship and long‐term follow‐up to detect recurrence. Recent advances in molecular diagnostics and imaging are reshaping early detection and targeted therapy, with implications for resource‐limited settings and global health initiatives.

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Management of Brain Abscesses and Associated Infections publication trend

The graph below shows the total number of articles in management of brain abscesses and associated infections across all publications each year (not limited to Nature Index journals).

Technical terms

Brain abscess: A localised intracerebral collection of pus, typically encapsulated by a vascularised membrane, arising from infection within or contiguous to the central nervous system.

Empirical antibiotic therapy: The initiation of broad-spectrum antimicrobials based on probable pathogens and clinical presentation, pending definitive microbiological identification.

Diffusion-weighted imaging (DWI): An MRI sequence sensitive to the Brownian motion of water molecules, used to distinguish abscess cavities from other intracranial lesions by detecting restricted diffusion within pus.

Whole-metagenome sequencing: A high-throughput molecular technique that analyses the entire genetic content of a sample, enabling identification of bacterial species without prior culture.

References

1. Paraclostridium tenue Causing an Anaerobic Brain Abscess Identified by Whole-Metagenome Sequencing: A Case Report. Microorganisms (2024).
2. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. Journal of Infection (2020).
3. Cerebral abscesses imaging: A practical approach. Journal of Population Therapeutics and Clinical Pharmacology (2020).