Difficulties in the diagnosis of brain abscesses

The diagnosis of brain abscesses has been improved during the last 10 years because to introduction of computerized tomography (CCT) and improved methods for the analysis of cerebrospinal fluid (CSF). Typical ring-like enhancement in the CT and an elevated CSF cell count combined with disturbances of the blood-brain barrier and elevated CSF lactate are common and confirm preliminary diagnoses. However, in spite of these procedures, brain abscess is still sometimes misdiagnosed because of the lack of pathological CT findings or a misleading case history sometimes causing cerebral affections. We present the case histories of two young patients in whom diagnosis of brain abscess was delayed. We recommend the immediate performance of contrast-enhanced CT and CSF analysis. If these procedures do not exclude a brain abscess, antibiotic treatment should be begun immediately.