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Cerebral abscess is a medical emergency. Intracranial pressure may become high enough to cause death. Hospitalization is required until the condition is stabilized.
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Life support may be required in some cases.
Medication, not surgery, is advised for multiple abscesses, a small abscess (less than 2 cm), an abscess deep within the brain, an abscess accompanied by meningitis, the presence of shunts in the brain (for hydrocephalus), or an underlying disease that makes surgery dangerous (debilitating disease). A needle biopsy is usually performed to identify the infecting organism.
Antimicrobials are given, initially through a vein, then by mouth. Antibiotics that work against a number of different bacteria (broad spectrum antibiotics) are the most common antimicrobial prescribed. It is not uncommon for multiple antibiotic medications to be used to ensure effective treatment. Antifungal medications may also be prescribed if fungal infection is likely.
An abscess that is injuring brain tissue by pressing on it or a large abscess with a high degree of swelling around it can raise intracranial pressure to the point where immediate treatment is needed.
Surgery is required if there is persistent or progressive increase in intracranial pressure, if the mass does not reduce after use of antimicrobial medications, or if the mass contains gas (produced by some types of bacteria). Surgery may also be needed if there are signs of impending rupture of the abscess into the fluid-containing system of the brain (the ventricles).
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