Element contents
Intracranial Abscess in Adults
Published online by Cambridge University Press: 12 December 2025
Summary
Adult cerebral infections are a common neurosurgical emergency presentation in the UK. This Element provides a comprehensive guide for clinicians, detailing the epidemiology, aetiology, and risk factors associated with the various types of cerebral infections including cerebral abscess, subdural empyema, epidural abscess and cranial fungal and parasitic infections. The clinical presentation, diagnostic methods, and treatment options, including surgical and antibiotic management, are discussed. Emphasis is placed on the importance of early diagnosis and tailored treatment plans. Flow diagrams summarizing the management of cerebral infections are also provided in this Element.
Information
- Type
- Element
- Information
- Online ISBN: 9781009487498Publisher: Cambridge University PressPrint publication: 22 January 2026
References
Helweg-Larsen, J, Astradsson, A, Richhall, H, et al. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis. 30 November 2012 ;12:332.CrossRefGoogle ScholarPubMed
Hollin, SA, Hayashi, H, Gross, SW. Intracranial abscesses of odontogenic origin. Oral Surg Oral Med Oral Pathol. March 1967;23(3):277–93.CrossRefGoogle ScholarPubMed
Dupuis-Girod, S, Giraud, S, Decullier, E, et al. Hemorrhagic hereditary telangiectasia (Rendu-Osler disease) and infectious diseases: An underestimated association. Clin Infect Dis. 15 March 2007;44(6):841–5.Google ScholarPubMed
Kao, PT, Tseng, HK, Liu, CP, SC, Su, Lee, CM. Brain abscess: Clinical analysis of 53 cases. J Microbiol Immunol Infect. June 2003;36(2):129–36.Google ScholarPubMed
Darlow, CA, McGlashan, N, Kerr, R, et al. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. J Infect. 2020;80(6):623–9.CrossRefGoogle Scholar
Li, X, Tronstad, L, Olsen, I. Brain abscesses caused by oral infection. Endod Dent Traumatol. June 1999;15(3):95–101.CrossRefGoogle ScholarPubMed
Weerakkody, RM, Palangasinghe, DR, Wadanambi, S, Wijewikrama, ES. ‘Primary’ nocardial brain abscess in a renal transplant patient. BMC Res Notes. 23 November 2015;8:701.CrossRefGoogle Scholar
Britt, RH, Enzmann, DR, Yeager, AS. Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg. 1981;55(4):590–603.CrossRefGoogle ScholarPubMed
Lee, TH, Chang, WN, Su, TM, et al. Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses. J Neurol Neurosurg Psychiatry. March 2007;78(3):303–9.Google ScholarPubMed
Cartes-Zumelzu, FW, Stavrou, I, Castillo, M, et al. Diffusion-weighted imaging in the assessment of brain abscesses therapy. AJNR Am J Neuroradiol. September 2004;25(8):1310–7.Google ScholarPubMed
Luthra, G, Parihar, A, Nath, K, et al. Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging and proton MR spectroscopy. AJNR Am J Neuroradiol. August 2007;28(7):1332–8.CrossRefGoogle ScholarPubMed
Arlotti, M, Grossi, P, Pea, F, et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: Bacterial brain abscesses. Int J Infect Dis. October 2010;14 Suppl 4:S79–92.CrossRefGoogle Scholar
Rosenblum, ML, Hoff, JT, Norman, D, Edwards, MS, Berg, BO. Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg. February 1980;52(2):217–25.CrossRefGoogle ScholarPubMed
Mamelak, AN, Mampalam, TJ, Obana, WG, Rosenblum, ML. Improved management of multiple brain abscesses: A combined surgical and medical approach. Neurosurgery. January 1995;36(1):76–85; discussion 85–6.CrossRefGoogle ScholarPubMed
Osborn, MK, Steinberg, JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. January 2007;7(1):62–7.CrossRefGoogle ScholarPubMed
Munusamy, T, Dinesh, SK. Delayed occurrence of escherichia coli subdural empyema following head injury in an elderly patient: A case report and literature review. J Neurol Surg Rep. July 2015;76(1):e79–82.Google Scholar
Critchley, G, Strachan, R. Postoperative subdural empyema caused by Propionibacterium acnes – A report of two cases. Br J Neurosurg. June 1996;10(3):321–3.CrossRefGoogle ScholarPubMed
Cowie, R, Williams, B. Late seizures and morbidity after subdural empyema. J Neurosurg. April 1983;58(4):569–73.CrossRefGoogle ScholarPubMed
French, H, Schaefer, N, Keijzers, G, Barison, D, Olson, S. Intracranial subdural empyema: A 10-year case series. Ochsner J. 2014;14(2):188–94.Google ScholarPubMed
Weisberg, L. Subdural empyema: Clinical and computed tomographic correlations. Arch Neurol. May 1986;43(5):497–500.CrossRefGoogle ScholarPubMed
Wong, AM, Zimmerman, RA, Simon, EM, Pollock, AN, Bilaniuk, LT. Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol. 25(6):1016–21.Google Scholar
Mauser, HW, Ravijst, RA, Elderson, A, van Gijn, J, Tulleken, CA. Nonsurgical treatment of subdural empyema: Case report. J Neurosurg. July 1985;63(1):128–30.Google ScholarPubMed
Leys, D, Destee, A, Petit, H, Warot, P. Management of subdural intracranial empyemas should not always require surgery. J Neurol Neurosurg Psychiatry. June 1986;49(6):635–9.CrossRefGoogle Scholar
Bok, AP, Peter, JC. Subdural empyema: Burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases. J Neurosurg. April 1993;78(4):574–8.CrossRefGoogle ScholarPubMed
Nathoo, N, Nadvi, SS, van Dellen, JR. Cranial extradural empyema in the era of computed tomography: A review of 82 cases. Neurosurgery. April 1999;44(4):748–53; discussion 753–4.Google ScholarPubMed
Pradilla, G, Ardila, GP, Hsu, W, Rigamonti, D. Epidural abscesses of the CNS. Lancet Neurol. March 2009;8(3):292–300.CrossRefGoogle ScholarPubMed
Weingarten, K, Zimmerman, RD, Becker, RD, et al. Subdural and epidural empyemas: MR imaging. AJR Am J Roentgenol. March 1989;152(3):615–21.CrossRefGoogle ScholarPubMed
Tsuchiya, K, Osawa, A, Katase, S, et al. Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. April 2003;45(4):220–3.CrossRefGoogle ScholarPubMed
Mitchell, TG, Perfect, JR. Cryptococcosis in the era of AIDS–100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev. October 1995;8(4):515–48.CrossRefGoogle ScholarPubMed
Kaplan, JE, Benson, C, Holmes, KK, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 10 April 2009;58(RR-4):1–207; quiz CE1-4.Google Scholar
CDC. DPDx – Laboratory identification of parasites of public health concern. 2019 [cited 4 September 2022]. Cysticercosis. www.cdc.gov/dpdx/cysticercosis/index.html.Google Scholar
Garcia, HH, Del, Brutto OH, Cysticercosis Working Group in Peru. Neurocysticercosis: Updated concepts about an old disease. Lancet Neurol. October 2005;4(10):653–61.CrossRefGoogle Scholar
Tsang, VC, Brand, JA, Boyer, AE. An enzyme-linked immunoelectrotransfer blot assay and glycoprotein antigens for diagnosing human cysticercosis (Taenia solium). J Infect Dis. January 1989;159(1):50–9.CrossRefGoogle ScholarPubMed
Mitchell, WG, Crawford, TO. Intraparenchymal cerebral cysticercosis in children: Diagnosis and treatment. Pediatrics. July 1988;82(1):76–82.Google ScholarPubMed
Del Brutto, OH, Santibañez, R, Noboa, CA, et al. Epilepsy due to neurocysticercosis: Analysis of 203 patients. Neurology. February 1992;42(2):389–92.CrossRefGoogle ScholarPubMed
Del, Brutto OH. Prognostic factors for seizure recurrence after withdrawal of antiepileptic drugs in patients with neurocysticercosis. Neurology. September 1994;44(9):1706–9.Google Scholar
Brunetti, E, White, AC. Cestode infestations: Hydatid disease and cysticercosis. Infect Dis Clin North Am. June 2012;26(2):421–35.CrossRefGoogle ScholarPubMed
Abdel Razek, AAK, El-Shamam, O, Abdel Wahab, N. Magnetic resonance appearance of cerebral cystic echinococcosis: World Health Organization (WHO) classification. Acta Radiol. June 2009;50(5):549–54.Google ScholarPubMed
Carrea, R, Dowling, E, Guevara, JA. Surgical treatment of hydatid cysts of the central nervous system in the pediatric age (Dowling’s technique). Childs Brain. 1975;1(1):4–21.Google ScholarPubMed
Accessibility standard: WCAG 2.1 AA
Why this information is here
This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.Accessibility Information
The PDF of this Element
complies with version 2.1 of the
Web Content Accessibility Guidelines
(WCAG), covering newer accessibility requirements and improved
user experiences and achieves the intermediate
(AA)
level of WCAG compliance, covering a wider range of accessibility requirements.
Content Navigation
Table of contents navigation
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Allows you to navigate directly to chapters, sections, or non‐text items through a linked table of contents, reducing the need for extensive scrolling.
Reading Order & Textual Equivalents
Single logical reading order
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
You will encounter all content (including footnotes, captions, etc.) in a clear, sequential flow, making it easier to follow with assistive tools like screen readers.
Short alternative textual descriptions
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
You get concise descriptions (for images, charts, or media clips), ensuring you do not miss crucial information when visual or audio elements are not accessible.
Visual Accessibility
Use of colour is not sole means of conveying information
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
You will still understand key ideas or prompts without relying solely on colour, which is especially helpful if you have colour vision deficiencies.
Structural and Technical Features
ARIA roles provided
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.
You gain clarity from ARIA (Accessible Rich Internet Applications) roles and attributes, as they help assistive technologies interpret how each part of the content functions.