Brain Abscess in Children

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KEY POINTS

• A brain abscess happens after your child has an infection of the brain, and a pocket of pus forms in the brain.
• Your child may need treatment with medicine and surgery, and your child will need to stay in the hospital.
• Ask your child’s healthcare provider how long it will take to recover, when your child can return to normal activities, and how to take care of your child at home.

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What is a brain abscess?

A brain abscess happens after your child has had an infection of the brain. The body forms a small pocket surrounding the infection called an abscess. The abscess contains pus. Pus is a thick fluid that usually contains white blood cells, dead tissue, and germs.

Brain abscesses are rare. They are more likely in school-age children. They happen in boys more than in girls.

What is the cause?

Your child can get an infection of the brain from different types of germs including bacteria or fungus. The infection can get to your child’s brain by moving from another part of the body through the blood. The source may be an infection that started in your child’s sinuses, ears, mouth, lungs, heart, or other places. Your child can also get an infection after surgery on the brain or from another kind of wound in the brain caused by trauma from being hit in the head with an object or some other head injury.

The infection makes cells in the brain die. The infected area of the brain may have inflammation (swelling and redness) and may form pus. Your child’s body tries to protect the rest of the brain from the infection and the pus by forming a wall around the area, which creates the abscess.

Your child has a greater risk of having a brain abscess if your child has heart disease present at birth, a long-term sinus or ear infection, or a shunt used to drain fluid from the brain.

Abscesses can form anywhere in the body. They are more common and may be harder to treat in children who have diabetes or poor circulation, and in children whose immune systems are weakened by HIV or AIDS, cancer, or other health problems.

What are the symptoms?

Symptoms of a brain abscess may come on slowly, or they may start quickly. Pressure inside the head (skull) can be caused by swelling or a buildup of blood and fluids in some parts of your child’s brain. Symptoms can be different based on where the abscess is in your child’s brain. Different parts of the brain control different parts of the body. Symptoms of a brain abscess in your child’s head may include:

• Fever and chills
• Headache or, in infants, a bulging soft spot on the top of the head
• Sleepiness
• Change in behavior or irritability
• Nausea and vomiting, or poor feeding
• Problems with speech
• High pitched cry in infants
• Trouble walking, or weakness in one part of the body
• Extra arm and leg movements that can’t be controlled
• Seizures

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Tests may include:

• A neurological exam, which is a group of tests to check your child’s balance and walking, speech and memory, face and eye movements, muscle strength and reflexes, and your child’s ability to see, hear, taste, and smell
• MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the brain
• CT, which uses X-rays and a computer to show detailed pictures of the brain
• Your child’s healthcare provider may measure the distance around your child’s head to check for swelling.

Your child may have tests to find out what kind of germ is causing the infection. These tests may include:

• Blood tests that may include blood cultures. The blood is sent to the lab and tested for many things including growth of bacteria or other germs. It may take several days to find out if and what kind of germ is causing the abscess. Knowing what germ is causing the infection helps your child’s provider choose the right medicine to treat it.
• Urine tests
• Biopsy of the brain, which is the removal of a small sample of brain tissue for testing from the abscess area. When your child has a biopsy, your child’s healthcare provider will give anesthesia medicine first so that your child will not feel any pain.
• Lumbar puncture, also called a spinal tap, which uses a needle to get a sample of fluid from the area around the spinal cord

How is it treated?

The treatment of a brain abscess depends on the location and type of infection your child has. Treatment must start right away, and your child will stay in the hospital. Your child may be in the intensive care unit (ICU) until symptoms improve.

• Your child will be given IV fluids and antibiotic medicine to treat the infection. Antibiotic medicines treat infections either by killing bacteria or by stopping their growth. Your child may need more than one type of antibiotic medicine for some infections. If the infection is caused by a fungus, your child will need antifungal medicine.
• Your child may need other medicines to:
  • Treat pain
  • Prevent or treat seizures
  • Prevent or treat nausea and vomiting
  • Reduce fluid build-up in the brain and other tissues
  • Help your child rest
  • Control blood pressure
• Your child may need surgery to drain the abscess and reduce the pressure on the brain.

How can I take care of my child?

• Follow the full course of treatment prescribed by your child’s healthcare provider.
• Ask your child’s healthcare provider:
  • How and when you will get your child’s test results
  • How long it will take your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help my child avoid a brain abscess?

You can help your child avoid a brain abscess by helping take care of your child’s health. Your child should see a healthcare provider right away if your child has symptoms of an infection.

If your child has an infection, help your child take any medicine for as long as your child’s healthcare provider prescribes, even if your child feels better. If your child stops taking the medicine too soon, it may not kill all the germs and your child may get sick again. If your child has side effects from the medicine, talk to your child’s healthcare provider.