Diagnosis of brain abscess

The most important investigation to diagnose brain abscesses is cranial imaging, either cranial tomography (CT) or magnetic resonance imaging (MRI).8,9 These will usually show round contrast-enhancing lesions similar to intracranial malignancies. Using diffusion weight MRI a distinction can be made between tumor and cerebral abscess: typical brain abscesses are hyperintense on T2 and FLAIR images, show a cavity with ring enhancement on T1 with gadolinium and limited diffusion in the cavity. The microbiological diagnosis in brain abscesses can be difficult. In only a minority of cases the causative pathogen(s) is identified in blood cultures or CSF culture. Therefore, if no primary focus of infection can be identified, a stereotactic aspiration of the abscess should be considered.8,9 Both aerobe and anaerobe cultures of the aspirate should be performed.