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Pediatrics
Diagnosis
Brain
Pathology-Based Diagnoses
Infectious, Inflammatory, and Demyelinating Disease
Acquired Infections
Abscess, Brain
Abscess, Brain
Kevin R. Moore, MD; Miral D. Jhaveri, MD, MBA; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Localized infection of brain parenchyma, typically bacterial; fungal or parasitic less common
              • 4 pathologic stages: Early cerebritis, late cerebritis, early capsule, and late capsule

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Barbosa BC et al: Demyelinating lesions behaving like aggressive tumours on advanced MRI techniques. Neuroradiol J. 32(2):103-7, 2019
                                          2. Longo M et al: Predictors of reoperation and noninfectious complications following craniotomy for cerebral abscess. Clin Neurol Neurosurg. 179:55-9, 2019
                                          3. Quintas S et al: Neuroradiological worsening of brain abscess after adalimumab and methotrexate withdrawal: Do not forget Immune Reconstitution Inflammatory Syndrome. J Clin Neurosci. ePub, 2019
                                          4. Hazan G et al: Group A streptococcal brain abscess in children: two case reports and a review of the literature. Infect Dis (Lond). 50(2):145-9, 2018
                                          5. Simjian T et al: Dexamethasone Administration and Mortality in Patients with Brain Abscess: A Systematic Review and Meta-Analysis. World Neurosurg. 115:257-263, 2018
                                          6. Brouwer MC et al: Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis. 30(1):129-34, 2017
                                          7. Zhou W et al: A clinical report of two cases of cryptogenic brain abscess and a relevant literature review. Front Neurosci. 12:1054, 2018
                                          8. Sonneville R et al: An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. ePub, 2017
                                          9. Brouwer MC et al: Brain abscess. N Engl J Med. 371(5):447-56, 2014
                                          10. Chaudhary V et al: MR spectroscopy in the diagnosis of bacterial etiology in brain abscesses. Magn Reson Imaging. ePub, 2014
                                          11. Toh CH et al: Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                          12. Rath TJ et al: Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am. 22(4):585-607, 2012
                                          13. Ryu SW et al: Multiple ring-enhancing lesions in the brain. J Clin Neurosci. 19(5):743, 775, 2012
                                          14. Lai PH et al: Susceptibility-weighted imaging in patients with pyogenic brain abscesses at 1.5T: characteristics of the abscess capsule. AJNR Am J Neuroradiol. 33(5):910-4, 2012
                                          15. Nath K et al: Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions. Magn Reson Imaging. 27(2):198-206, 2009
                                          16. Sharma R et al: Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection. 37(1):39-43, 2009
                                          17. Cavuşoglu H et al: Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period. Neurosurg Focus. 24(6):E9, 2008
                                          18. Engh JA et al: Diffusion-weighted magnetic resonance imaging demonstrating intraventricular rupture of a cerebral abscess and subsequent therapeutic response. Surg Neurol. 70(5):526-30, 2008
                                          19. Gelabert-González M et al: Management of brain abscess in children. J Paediatr Child Health. 44(12):731-5, 2008
                                          20. Kastrup O et al: Neuroimaging of infections of the central nervous system. Semin Neurol. 28(4):511-22, 2008
                                          21. Menon S et al: Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol. 57(Pt 10):1259-68, 2008
                                          22. Moorthy RK et al: Management of brain abscess: an overview. Neurosurg Focus. 24(6):E3, 2008
                                          23. Song L et al: Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci. 29(6):425-30, 2008
                                          24. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                          25. Fertikh D et al: Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. J Neurosurg. 106(1):76-81, 2007
                                          26. Lai PH et al: Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol. 68 Suppl 1:S25-36, 2007
                                          27. McClelland S 3rd et al: Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 45(1):55-9, 2007
                                          28. Morais LT et al: Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses. Arq Neuropsiquiatr. 65(4B):1144-8, 2007
                                          29. Mueller-Mang C et al: Fungal versus bacterial brain abscesses: is diffusion-weighted MR imaging a useful tool in the differential diagnosis? Neuroradiology. 49(8):651-7, 2007
                                          30. Smirniotopoulos JG et al: Patterns of contrast enhancement in the brain and meninges. Radiographics. 27(2):525-51, 2007
                                          31. Plotnik AN et al: Multiple cystic ring-enhancing cerebral lesions. J Clin Neurosci. 13(9):933, 976, 2006
                                          32. Reddy JS et al: The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 66(3):246-50; discussion 250-1, 2006
                                          33. Bükte Y et al: Role of diffusion-weighted MR in differential diagnosis of intracranial cystic lesions. Clin Radiol. 60(3):375-83, 2005
                                          34. Erdogan C et al: Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr. 29(5):663-7, 2005
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Localized infection of brain parenchyma, typically bacterial; fungal or parasitic less common
                                                      • 4 pathologic stages: Early cerebritis, late cerebritis, early capsule, and late capsule

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Nuclear Medicine Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Barbosa BC et al: Demyelinating lesions behaving like aggressive tumours on advanced MRI techniques. Neuroradiol J. 32(2):103-7, 2019
                                                                                  2. Longo M et al: Predictors of reoperation and noninfectious complications following craniotomy for cerebral abscess. Clin Neurol Neurosurg. 179:55-9, 2019
                                                                                  3. Quintas S et al: Neuroradiological worsening of brain abscess after adalimumab and methotrexate withdrawal: Do not forget Immune Reconstitution Inflammatory Syndrome. J Clin Neurosci. ePub, 2019
                                                                                  4. Hazan G et al: Group A streptococcal brain abscess in children: two case reports and a review of the literature. Infect Dis (Lond). 50(2):145-9, 2018
                                                                                  5. Simjian T et al: Dexamethasone Administration and Mortality in Patients with Brain Abscess: A Systematic Review and Meta-Analysis. World Neurosurg. 115:257-263, 2018
                                                                                  6. Brouwer MC et al: Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis. 30(1):129-34, 2017
                                                                                  7. Zhou W et al: A clinical report of two cases of cryptogenic brain abscess and a relevant literature review. Front Neurosci. 12:1054, 2018
                                                                                  8. Sonneville R et al: An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. ePub, 2017
                                                                                  9. Brouwer MC et al: Brain abscess. N Engl J Med. 371(5):447-56, 2014
                                                                                  10. Chaudhary V et al: MR spectroscopy in the diagnosis of bacterial etiology in brain abscesses. Magn Reson Imaging. ePub, 2014
                                                                                  11. Toh CH et al: Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging. AJNR Am J Neuroradiol. Epub ahead of print, 2012
                                                                                  12. Rath TJ et al: Imaging of cerebritis, encephalitis, and brain abscess. Neuroimaging Clin N Am. 22(4):585-607, 2012
                                                                                  13. Ryu SW et al: Multiple ring-enhancing lesions in the brain. J Clin Neurosci. 19(5):743, 775, 2012
                                                                                  14. Lai PH et al: Susceptibility-weighted imaging in patients with pyogenic brain abscesses at 1.5T: characteristics of the abscess capsule. AJNR Am J Neuroradiol. 33(5):910-4, 2012
                                                                                  15. Nath K et al: Role of diffusion tensor imaging metrics and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of cystic intracranial mass lesions. Magn Reson Imaging. 27(2):198-206, 2009
                                                                                  16. Sharma R et al: Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection. 37(1):39-43, 2009
                                                                                  17. Cavuşoglu H et al: Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period. Neurosurg Focus. 24(6):E9, 2008
                                                                                  18. Engh JA et al: Diffusion-weighted magnetic resonance imaging demonstrating intraventricular rupture of a cerebral abscess and subsequent therapeutic response. Surg Neurol. 70(5):526-30, 2008
                                                                                  19. Gelabert-González M et al: Management of brain abscess in children. J Paediatr Child Health. 44(12):731-5, 2008
                                                                                  20. Kastrup O et al: Neuroimaging of infections of the central nervous system. Semin Neurol. 28(4):511-22, 2008
                                                                                  21. Menon S et al: Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol. 57(Pt 10):1259-68, 2008
                                                                                  22. Moorthy RK et al: Management of brain abscess: an overview. Neurosurg Focus. 24(6):E3, 2008
                                                                                  23. Song L et al: Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci. 29(6):425-30, 2008
                                                                                  24. Ziai WC et al: Update in the diagnosis and management of central nervous system infections. Neurol Clin. 26(2):427-68, viii, 2008
                                                                                  25. Fertikh D et al: Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. J Neurosurg. 106(1):76-81, 2007
                                                                                  26. Lai PH et al: Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol. 68 Suppl 1:S25-36, 2007
                                                                                  27. McClelland S 3rd et al: Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 45(1):55-9, 2007
                                                                                  28. Morais LT et al: Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses. Arq Neuropsiquiatr. 65(4B):1144-8, 2007
                                                                                  29. Mueller-Mang C et al: Fungal versus bacterial brain abscesses: is diffusion-weighted MR imaging a useful tool in the differential diagnosis? Neuroradiology. 49(8):651-7, 2007
                                                                                  30. Smirniotopoulos JG et al: Patterns of contrast enhancement in the brain and meninges. Radiographics. 27(2):525-51, 2007
                                                                                  31. Plotnik AN et al: Multiple cystic ring-enhancing cerebral lesions. J Clin Neurosci. 13(9):933, 976, 2006
                                                                                  32. Reddy JS et al: The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 66(3):246-50; discussion 250-1, 2006
                                                                                  33. Bükte Y et al: Role of diffusion-weighted MR in differential diagnosis of intracranial cystic lesions. Clin Radiol. 60(3):375-83, 2005
                                                                                  34. Erdogan C et al: Brain abscess and cystic brain tumor: discrimination with dynamic susceptibility contrast perfusion-weighted MRI. J Comput Assist Tomogr. 29(5):663-7, 2005