A brain abscess is a medical emergency. Pressure inside the skull may become high enough to be life threatening. You will need to stay in the hospital until the condition is stable. Some people may need life support.
Medication, not surgery, is recommended if you have:
- Several abscesses (rare)
- A small abscess (less than 2 cm)
- An abscess deep in the brain
- An abscess and meningitis
- Shunts in the brain for hydrocephalus (in some cases the shunt may need to be removed temporarily or replaced)
- Toxoplasma gondii infection in a person with HIV
Antibiotics will be prescribed. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are most commonly used. You may be prescribed several different types of antibiotics to make sure treatment works.
Antifungal medications may also be prescribed if the infection is likely caused by a fungus.
Immediate treatment may be needed if an abscess is injuring brain tissue by pressing on it, or there is a large abscess with a large amount of swelling around that it is raising pressure in the brain.
Surgery is needed if :
- Increased pressure in the brain continues or gets worse
- The brain abscess does not get smaller after medication
- The brain abscess contains gas (produced by some types of bacteria)
- The brain abscess might break open (rupture)
Surgery consists of opening the skull, exposing the brain, and draining the abscess. Laboratory tests are often done to examine the fluid. This can help identify what is causing the infection, so that more appropriate antibiotics or antifungal drugs can be prescribed.
The surgical procedure used depends on the size and depth of the abscess. The entire abscess may be removed (excised) if it is near the surface and enclosed in a sac.
Needle aspiration guided by CT or MRI scan may be needed for a deep abscess. During this procedure, medications may be injected directly into the mass.
Certain diuretics and steroids may also be used to reduce swelling of the brain.