Clinical suspicion of brain abscess

MRI with contrast

Single or multiple ring enhancing lesions

Craniotomy or sterotactic aspiration of all abscess >3 cm or those causing significant mass effect

Empiric treatment (See treatment section)

Stat gram stain and cultures

Consider work up for abscess mimics like necrotic tumors or hematoma/hemorrhage

Antimicrobials, based on gram stain if positive, or empiric therapy. Tailor therapy based on microbiology.

Clinical assessment and repeat MRI in 2 weeks or earlier if there is clinical deterioration

Repeat sterotactic aspiration or consider if craniotomy and excision is needed

 RETURN

Clinical assessment and repeat MRI every 4 weeks if there is clinical and radiological resolution

End

Candidate for surgical therapy (see surgical treatment section)

YES

NO

Purulence or gross appearance of an abscess

YES

NO

Increase in size of lesions or mass effect

YES

NO