Intracranial Abscess

FACTS

  • Often polymicrobial, but Staph aureus #1 (50—70%)
  • S. pneumoniae is a common cause of meningitis but not abscesses
 
Refer to the following article for very similar HPI/physical exam/plans
Discitis / Osteomyelitis

HPI

  • Any IVDU
  • Any prolonged use of lines this hospitalization

PHYSICAL EXAM

evaluate for peripheral neuropathy, venous stasis in LEs
evaluate dentition
evaluate all incisions

IMAGING

  • Evaluate for any IPH, which would prompt you to perform a DSA to evaluate for co-occurring mycotic aneurysms
  • Rim-enhancing, diffusion restricting cerebral abscesses
Figure 1: (LEFT): DWI shows diffusion restriction with (MIDDLE/RIGHT) T1 and T1+c sequences showing classic rim-enhancing
Figure 1: (LEFT): DWI shows diffusion restriction with (MIDDLE/RIGHT) T1 and T1+c sequences showing classic rim-enhancing
 
A/P
  • ID consult for medical management
    • CNS penetrating triple ABx: Vanc to be dosed w/ troughs, flagyl 500, CTX 2q12
    • TEE to evaluate for endocarditis
    • BCx
    • CTAP to ensure to evidence of body abscsses
  • Generally only drain surgically if medical management has failed or if symptoms referrable to mass lesion
  • Consider DSA to evaluate for mycotic aneurysm if IPH is present