When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Absceso cerebral

View PDF
  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 9 Aug 2025
Last updated: 23 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • sexo masculino
  • edad <30 años
  • meningismo
  • cefalea
  • parálisis de pares craneales
  • signo de Kernig o Brudzinski positivo
  • fiebre
  • aumento de la circunferencia de la cabeza (lactantes)
  • fontanelas abultadas (lactantes)
Full details

Other diagnostic factors

  • déficit neurológico
  • papiledema
Full details

Risk factors

  • sinusitis
  • otitis media
  • procedimiento/infección dental
  • meningitis
  • cirugía reciente de cabeza y cuello o neurocirugía
  • cardiopatía congénita
  • endocarditis
  • enfermedad diverticular
  • telangiectasia hemorrágica hereditaria o malformación arteriovenosa
  • diabetes mellitus
  • VIH o compromiso inmunológico
  • consumo de drogas ilícitas por vía intravenosa
  • enfermedad granulomatosa crónica
  • hemodiálisis
  • prematuridad en el nacimiento
  • fibrosis quística
Full details

Diagnostic tests

1st tests to order

  • hemograma completo (HC)
  • velocidad de sedimentación globular (VSG) sérica
  • proteína C-reactiva sérica
  • TP sérico, TTP e INR
  • hemocultivo
  • resonancia magnética (IRM) con contraste
  • tomografía computarizada (TC) de cabeza con y sin contraste
  • ultrasonido de cabeza (lactantes)
Full details

Tests to consider

  • título de toxoplasma sérico
  • espectroscopia por resonancia magnética (ERM)
  • punción lumbar (PL) con análisis de líquido cefalorraquídeo (LCR)
  • tomografía computarizada (TC) de tórax, abdomen y pelvis
  • gammagrafía ósea
  • mamografía
Full details

Treatment algorithm

INITIAL

absceso cerebral presunto

ACUTE

etiología bacteriana sospechada o confirmada

etiología fúngica confirmada

etiología parasitaria sospechada o confirmada

absceso cerebral criptogénico

Contributors

Authors

Walter A. Hall, MD, MBA

Professor

Department of Neurosurgery

SUNY Upstate Medical University

Syracuse

NY

Disclosures

WAH is an author of a number of references cited in this topic.

Acknowledgements

Dr Walter A. Hall would like to gratefully acknowledge Dr Peter D. Kim, a previous contributor to this topic. PDK declares that he has no competing interests.

Peer reviewers

Stephen Haines, MD

Professor and Head

Department of Neurosurgery

University of Minnesota

Minneapolis

MN

Disclosures

SH and WAH were colleagues on a faculty of the University of Minnesota between 1991 and 1997 and again between 2004 and 2006. They have coauthored articles on neurosurgical infection.

Sabrina Ravaglia, MD, PhD

Staff Physician

Department of Neurological Sciences

Institute of Neurology C. Mondino

Pavia

Italy

Disclosures

SR declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014 Mar 4;82(9):806-13. Abstract

Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurgery. 2008 Feb;62(2 suppl):519-30. Abstract

Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics. 2004 Jun;113(6):1765-70. Abstract

Expert Panel on Neurologic Imaging; Whitehead MT, Cardenas AM, et al. ACR Appropriateness Criteria® headache. J Am Coll Radiol. 2019 Nov;16(11s):S364-77.Full text  Abstract

American College of Radiology. ACR-ASNR-SPR practice parameter for the performance and interpretation of magnetic resonance spectroscopy of the central nervous system. 2019 [internet publication].Full text

Infection in Neurosurgery Working Party of the British Society for Antimicrobial Chemotherapy. The rational use of antibiotics in the treatment of brain abscess. Br J Neurosurg. 2000 Dec;14(6):525-30. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Absceso cerebral images

  • Differentials

    • Neoplasia primaria del sistema nervioso central
    • Lesión metastásica
    • Tumor recurrente/necrosis por radiación en un paciente posquirúrgico
    More Differentials

  • Guidelines

    • Anaerobic infections (individual fields): central nervous system infections (brain abscess, subdural abscess, epidural abscess and bacterial meningitis)
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer