ArticleDiagnosis and Treatment of Nocardial Brain AbscessBose, Bikash*†; Balzarini, Michael*Author Information *Department of Neurosurgery, Christiana Care Health System, Newark, Delaware, and †Department of Neurosurgery,Jefferson Medical College, Philadelphia, Pennsylvania Address correspondence and reprint requests to Bikash Bose, MD, FACS, C-79 Omega Drive, Newark, DE 19713. E-mail: RANA1@msn.com. Neurosurgery Quarterly: June 2002 - Volume 12 - Issue 2 - p 182-193 Buy Abstract Cerebral abscess from Nocardia sp. is difficult to diagnose, particularly when it occurs as a primary lesion. Confirmed diagnosis requires a positive culture obtained from an invasive procedure, and an additional 1 to 4 weeks may be needed before the causative organism can be identified. Like most brain lesions, the likelihood of successful management of a Nocardia asteroides brain abscess increases with early diagnosis. For this reason, and because a nocardial brain abscess can progress rapidly, a presumptive diagnosis is often necessary. This requires that clinicians maintain a suspicion of the likelihood of Nocardia sp. and a familiarity with disease characteristics. Diagnostic tools that assist in a presumptive diagnosis include early contrast computed tomography and magnetic resonance imaging scans. Nocardial infection as a primary brain lesion is rare; instead, it is more commonly encountered as a secondary lesion. More than 50% of patients who develop a primary lesion have no apparent risk factors. Secondary lesions as well as disease outside the central nervous system occur more frequently in immunocompromised patients. Treatment of a nocardial infection relies heavily on appropriate antibiotic therapy. The prognosis is best for most patients when surgical intervention augments antibiotic therapy, although the patient and progression of the disease play key roles in determining the therapeutic approach. In this report, we use a case study to illustrate the diagnosis and management of a nocardial brain abscess in an immunocompetent patient. We then review the typical clinical symptoms, diagnostic techniques, treatment, and factors affecting prognoses for nocardial brain abscesses in immunocompetent and immunocompromised patients. © 2002 Lippincott Williams & Wilkins, Inc.