The clinical presentation of intracranial abscesses.

A retrospective case note survey of 67 surgically proven cases of intracranial abscess formation has been carried out. Males predominated, especially in the third decade. Only 15 per cent had a predisposing condition such as cyanotic heart disease though the majority had some evidence of a systemic infection or fever. A peripheral leucocytosis and elevated erythrocyte sedimentation rate (ESR) were also more frequently encountered than in a comparable group of cases of cerebral tumour. Despite these pointers to an infective process the correct diagnosis was commonly not considered on admission. Headache, vomiting, drowsiness and focal symptoms sometimes accompanied by focal or generalized seizures remain the classical features in the history, with papilloedema and focal signs commonly found in a drowsy ill-looking patient. Many individuals failed to show all these features however. The progressive nature of the clinical picture should itself be enough to prompt urgent referral for investigation, electro-encephalography, nuclear scanning and CT scanning all being reliable.