Although rare, it is a serious life threatening entity of pediatric emergency medicine
Must be in the differential of those with signs of increased intracranial pressure or focal deficit and hx of sinusitis, mastoiditis or cyanotic congenital heart disease.
Investigation and diagnosis primarily with CT scan
CSF studies demonstrate sterile fluid with elevated protein, and mildly elevated WBC
Antibiotic coverage should be broad Naficillin/Vanc + Ceftriaxone + Metronidazole, until speciation and susceptibilities obtained from surgical specimen
Steroids reserved only in cases of imminent herniation
Controversy exists over prophylactic anticonvulsants
Mortality recently <10% attributed to early diagnosis and appropriate antibiotic coverage.
References
Cochrane, D. "Consultation with the Specialist: Brain Abscess," Pediatrics in Review 1999 20: 209-215.
Red Book, American Academy of Peditrics Report of the Committee on Infectious Diseases
