Brain Abscess in Children

What is a brain abscess in children?

An abscess is a pocket of infection. In the brain, an abscess may be in one or more areas. This condition may cause problems with how the brain and spinal cord function. It's a serious and life-threatening condition that needs to be treated right away.

What causes a brain abscess in a child?

The more common causes of a brain abscess in children are fungi and bacteria. Bacteria are the most common cause. Bacteria and fungi can infect the brain in these ways:

• Infection spreads from another area of the body, usually nearby. This may be an ear infection, sinus infection, or dental infection.
• Infection is spread through the bloodstream from the lung or chest area, from the heart (endocarditis), or from the cerebrospinal fluid (CSF) to the brain (meningitis).
• Fungi or bacteria enter the brain through a wound in the head.

Which children are at risk for a brain abscess?

A child is more at risk for a brain abscess if they have any of these:

• Heart disease that is present from birth (congenital)
• Meningitis
• Long-term (chronic) middle ear and sinus infections
• Dental or jaw infections
• Infections of the face or scalp
• Head injury or skull fracture
• Diabetes
• A treatment for broken neck or postsurgery called traction, which uses pins or screws in the skull to hold the head and neck still
• Infection of a small tube (shunt) used to drain extra CSF
• A weak immune system caused by medicines or health conditions, such as HIV infection

What are the symptoms of a brain abscess in a child?

The infection may cause increased pressure inside the head and cause symptoms. Symptoms can occur a bit differently in each child.

Symptoms in babies and younger children can include:

• Fever
• Bulging of the soft spots on the head (fontanelles)
• Abnormal sleepiness or being less alert than normal
• Increased irritability
• High-pitched cry
• Poor feeding
• Projectile vomiting
• Complaint of severe headache
• Seizures

Symptoms in older children can include:

• Fever
• Headache
• Pain, often on the side of the abscess
• Neck stiffness
• Nausea and vomiting
• Changes in personality, alertness, or behavior
• Changes in speech
• Problems walking
• Decreased movement in the arms or legs (paralysis or weakness)
• Seizures

The symptoms of a brain abscess can be like other health problems. Make sure your child sees their healthcare provider right away for a diagnosis.

How is a brain abscess diagnosed in a child?

Your child's healthcare provider will ask about your child's symptoms and health history. They will do a physical exam. The exam will include measuring your child’s head. The healthcare provider will compare that measurement with numbers that range from normal to abnormal.

Your child may also need tests, such as:

• Blood tests. These are to check for infection and other problems.
• X-ray. This test uses a small amount of radiation to make pictures of your child's skull. A skull X-ray likely won't show a brain abscess. But it can show if there are breaks in the bone that may have caused an abscess.
• MRI. This test uses large magnets, radio waves, and a computer to make images of the inside of the body. Your child may be given a contrast dye to help the abscess show up more clearly.
• CT scan. This test uses a series of X-rays and a computer to create images of the inside of the body. A CT scan shows more detail than a regular X-ray. Your child may be given a contrast dye to help the abscess show up more clearly.
• Ultrasound. This test is best for very young children. Sound waves create a picture and can find major abnormalities.
• Urine and stool tests. These are done to check for infection and other problems.
• Sputum culture. This test looks at mucus that is coughed up from the lungs. This test is done to find out if your child has a lung infection.
• Blood culture. Blood is collected and cultured to look for bacteria or fungi.
• Spinal tap ( lumbar puncture). This test uses a needle to help measure the pressure in the spinal canal and brain. The healthcare provider can also remove a small amount of CSF to send for testing. CSF is the fluid that surrounds your child's brain and spinal cord. The fluid sample can help show if your child has an infection or other problems. It's important to find out what may be causing the abscess, because treatment depends on the cause. This test may not be done or may be delayed if your child has brain swelling or a shift in the brain tissue.

How is a brain abscess treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The key to treating a brain abscess is finding and treating it early. A child with a brain abscess needs to be hospitalized right away. The healthcare provider will give your child antibiotics and watch your child closely. Your child may need surgery to drain the abscess. The surgery will also take a sample of the abscess to be looked at in a lab.

The goal of treatment is to reduce the pressure in the head and to correctly drain the infection. Medicines are used to control the infection, seizures, fever, and other problems. Other organs may be affected by the brain abscess. In severe cases, your child may need a breathing machine (ventilator) to help them breathe easier.

As your child recovers, they may need physical, occupational, or speech therapy. This will help your child regain muscle strength, speech skills, or both.

Your child's healthcare team will help you learn how to best care for your child at home. They will tell you what problems to watch for that need medical attention right away. Your child will need to see their healthcare provider often after treatment ends.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

What are possible complications of a brain abscess in a child?

After treatment, many children recover fully with few or no problems. Some children will have ongoing nervous system problems, such as trouble with speech or movement. Some may have seizures. Your child may need regular follow-up with the healthcare provider. Your child may need speech, physical, or occupational therapy to recover.

When should I call my child’s healthcare provider?

A brain abscess is a serious and life-threatening condition that needs to be treated right away. If your child has symptoms, call your child’s healthcare provider right away.

After treatment for a brain abscess, call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms

Key points about a brain abscess in children

• A brain abscess is a serious and life-threatening condition that needs to be treated right away. This condition may cause problems with how the brain and spinal cord function.
• The more common causes of a brain abscess in children are viruses, fungi, and bacteria. Bacteria are the most common cause.
• Symptoms can include fever, severe headache, nausea and vomiting, and changes in behavior.
• The goal of treatment is to reduce the pressure in the head and correctly drain the infection. Medicines are used to control the infection, seizures, fever, and other problems.
• Other organs may be affected by the brain abscess. In severe cases, your child may need a breathing machine to help them breathe easier.
• As your child recovers, they may need physical, occupational, or speech therapy.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.