Brain abscess

Q: 30 years old male is brought to the Emergency Department (ED) with headache, fever, an episode of seizure at home, and focal deficit in the Right upper extremity. A STAT scan of the head showed a probable brain abscess. Per family, the patient was on a road trip in Latin America and returned from vacation two weeks ago. Lumbar Puncture (LP) is indicated.

A) Yes

B) No

Answer: B

Though seems surprising, LP has no role in patients with suspicion of brain abscess. In fact, it can cause brainstem herniation if the abscess is large and already causing a mass effect. Also, cerebrospinal fluid (CSF) is usually not very helpful. 

Further neurological imaging such as MRI, brain biopsy, and abscess drainage is indicated.

#procedures

#neurology

#ID

References:

1. Nadvi SS, Nathoo N, van Dellen JR. Lumbar puncture is dangerous in patients with brain abscess or subdural empyema. S Afr Med J. 2000 Jun;90(6):609-10. PMID: 10918891.

2. Sonneville R, Ruimy R, Benzonana N, Riffaud L, Carsin A, Tadié JM, Piau C, Revest M, Tattevin P; ESCMID Study Group for Infectious Diseases of the Brain (ESGIB). An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017 Sep;23(9):614-620. doi: 10.1016/j.cmi.2017.05.004. Epub 2017 May 10. PMID: 28501669.