Non-otogenic cerebral abscess

Non-otogenic cerebral abscess is becoming relatively more frequent compared with otogenic. It arises in a setting of sepsis, trauma, or congenital heart disease. The onset presents a meningo-encephalitic picture, often with two stages, followed by epilepsy and/or a hemiparesis. The best investigations are an EEG and, probably, an isotope scan. The angiogram may be misleading as 40% may not have a midline shift. ‘Acute localized non-suppurative encephalitis’ seems to be more frequent than in the past. Antibiotics and aspiration appear to be the best treatment.