Is Computerized Tomography Sufficient for the Diagnosis of Brain Abscess?

Brain Abscess (BA) is a focal suppurative process in the brain parenchyma. It is seen rarely in the Western population, with approximately 1500-2500 cases per year. They arise after the direct extension of infection from neighboring structures, hematogenous seeding of infectious agents, or trauma and neurosurgical complications. Symptoms of BA are non-specific and laboratory tests add little to the diagnosis. They develop in four stages and imaging characteristics of BAs differ according to the stage. The most important prognostic factor for BAs is the initial neurologic grade and diagnostic delay is a key contributing factor to the severity and outcome of BAs. This fact makes the timely diagnosis of BA in the Emergency Department (ED) very important. Here, we describe the case of a 20-year-old male who presented to ED with confusion, drowsiness and hypoacusis. While cranial computerized tomography reveals only localized brain edema, magnetic resonance imaging revealed the abscess with a fluid-fluid level and the patient was diagnosed as having a BA. The changing imaging characteristics of BAs make their diagnosis difficult. Timely diagnosis of BA is very important in ED. In selected patients, further imaging modalities such as magnetic resonance help to make the diagnosis properly.