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Clinical Manifestations Headache is the most frequent initial symptom of intracranial abscess Other early symptoms, roughly in order of their frequency, are drowsiness and confusion; focal or generalized seizures; and focal motor, sensory, or speech disorders Fever and leukocytosis are not consistently present, depending on the phase of the development of the abscess at the time of presentation (see below) In patients who harbor chronic ear, sinus, or pulmonary infections, a recent activation of the infection frequently precedes the onset of cerebral symptoms In patients without an obvious focus of infection, headache or other cerebral symptoms may appear abruptly on a background of mild general ill health or congenital heart disease In some patients, bacterial invasion of the brain may be asymptomatic or may be attended only by a transitory focal neurologic disorder, as might happen when a septic embolus lodges in a brain artery Sometimes stiff neck accompanies generalized headache, suggesting the diagnosis of meningitis (especially a partially treated one) These early symptoms may improve in response to antimicrobial agents, but within a few days or weeks, recurrent headache, slowness in mentation, focal or generalized convulsions, and obvious signs of increased intracranial pressure provide evidence of an in ammatory mass in the brain Localizing neurologic signs become evident sooner or later, but, like papilledema, they occur relatively late in the course of the illness However, as stated above, some patients present only with focal neurologic signs The nature of the focal neurologic defect will, of course, depend on the location of the abscess In temporal lobe abscess, headache in the early stages is usually on the same side as the abscess and is localized to the frontotemporal region If the abscess lies in the dominant temporal lobe, there is characteristically an anomic aphasia An upper homonymous quadrantanopia may be demonstrable owing to interruption of the inferior portion of the optic radiation This may be the only sign of abscess of the right temporal lobe; contralateral motor or sensory defects in the limbs tend to be minimal, though weakness of the lower face is often observed In frontal lobe abscess, headache, drowsiness, inattention, and general impairment of mental function are prominent Contralateral hemiparesis with motor seizures and a motor disorder of speech (with dominant hemisphere lesions) are the most frequent neurologic signs An abscess of the parietal lobe will give rise to a series of characteristic but sometimes subtle focal disturbances (page 400) The main manifestation of an occipital lobe lesion is a homonymous hemianopia All of the aforementioned focal signs may be obscured by inattentiveness, drowsiness, and stupor, and one must be persistent in searching for them When abscesses are multiple and widely distributed in the cerebral and cerebellar hemispheres, the ultimate syndrome is unpredictable; but most often, in our experience, it has taken the form of a global encephalopathy, like that of a metabolic confusional state, with a subtle hemiparesis or seizure In cerebellar abscess, headache in the postauricular or suboccipital region is usually the initial symptom and may at rst be ascribed to infection in the mastoid cells Coarse nystagmus, weakness of conjugate gaze to the side of the lesion, cerebellar ataxia of the ipsilateral arm and leg, and ataxia of gait are the usual signs The ataxia may be dif cult to demonstrate if the patient is very ill and cannot sit up or walk As a general rule, the signs of increased intracranial pressure are more prominent with cerebellar abscesses than with cerebral ones Mild contralateral or bilateral corticospinal tract signs are often misleading, being evidence of brainstem compression or hydrocephalus rather than a frontal lobe lesion In the. how to use barcode font in excel 2007 How Excel creates barcodes | PCWorld
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