SYMPTOMS/EXAM
■ Often mild course that may progress slowly over weeks
■ The vast majority of patients complain of headache.
■ Nuchal rigidity and fever in half
■ Focal neurologic deficits may occur.
■ Papilledema is not uncommon.
DIAGNOSIS
■ CT or MRI with contrast
■ Cannot exclude abscess with noncontrast studies
■ Classic finding = ring-enhancing lesion(s)
TREATMENT
■ Supportive therapy
■ Treat associated seizures.
■ Empiric antibiotic therapy
■ Depends on suspected source
■ No obvious source: Cefotaxime and metronidazole
■ Surgical versus medical therapy
■ Surgery for large abscesses
Neurocysticercosis
CNS infection with the larval form of the tapeworm Taenia solium;very
common in developing countries
MECHANISMS
Forms of disease:
■ Invasion of brain parenchyma (most common) →formation of cysts →
inflammation and fibrosis.
■ Cysterci in ventricles →obstructing hydrocephalus.
■ Cysterci in basilar cisterns →arachnoiditis →meningitis or communicating
hydrocephalus.
SYMPTOMS/EXAM
■ Seizure is the most common clinical finding.
■ Headache or signs of increased intracranial pressure are seen, if hydro-
cephalus develops.
DIAGNOSIS/TREATMENT
■ Based on exposure history, CT or MRI findings and serologic testing
■ Treatment depends on clinical manifestations (eg, antiseizure medications,
shunting procedure).
■ Antiparasitic agents
Shunt Infection
The majority of shunt infections present within 6 months of placement.
■ Common infecting organisms:
■ Staphylococcus epidermidis(half)
■ Staphylococcus aureus
■ Other organisms include Gram-negatives and anaerobes.
NEUROLOGYHeadache is uniformly present
in patients with brain abscess.