Abscess is also less deadly thanks to advanced diagnostic techniques and antibiotic regimens. New disease pathogens, however, have renewed concern about the diagnosis and treatment of brain abscess. Abscess usually begins as cerebritis, eventually becoming necrotic and subsequently encapsulated. Morbidity in survivors generally is due to residual focal defects, increased incidence of seizures due to scar tissue foci, or neuropsychiatric changes. To date, no differences in incidence of brain abscess by race have been apparent.
Men develop brain abscesses twice as often as women.
Classically, patients present to the ED with headache, low-grade fever, and a focal neurological defect or seizure. Patients may complain of nausea, vomiting, or stiff neck. Altered mental status ranges from subtle personality changes, to drowsiness, to full-blown coma. Focal neurological signs can signal increasing cerebral edema around the abscess. Seizures are typically grand mal.