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.
Papilledema indicates the disease process is well advanced. Of these, pulmonary infections traditionally have been cited as frequent sources, though dental infections are increasingly the primary site. Lab tests rarely are helpful in establishing a diagnosis. WBC often is elevated slightly. Early in the course, abscesses show up as low-density, irregular zones that do not enhance when contrast is given.