Clinical presentation of brain abscesses: from classic triad to silent forms

Despite relatively small incidence, brain abscesses are life-threatening with high risk of death and persistent neurological deficits. A key factor limiting early diagnosis is polymorphic and nonspecific clinical presentation. OBJECTIVE: To analyze the structure and incidence of clinical symptoms in a cohort of patients with brain abscesses treated at the Burdenko Neurosurgical Center. MATERIAL AND METHODS: A single-center study was based on medical records of patients with newly diagnosed and confirmed brain abscesses hospitalized for surgical treatment at the Burdenko Neurosurgery Center between January 2022 and December 2025. Verification was based on contrast-enhanced MRI and/or intraoperative data. RESULTS: The study included 41 patients with verified intracranial abscesses. The most common symptoms were headache (51.2%) and focal neurological deficit (48.8%). Fever was detected in 19.5% of patients, classic triad (headache, focal neurological deficit, fever) - in only 7.3% of patients. There were no symptoms (subclinical presentation) in 19.5% of patients. Atypical and silent forms of disease comprised 73.2%. CONCLUSION: Silent and atypical forms account for 73.2% of cases, while classic triad of symptoms is recorded in only 7.3% of patients. This decreases its diagnostic value. In this regard, patients with focal neurological symptoms or severe headaches, even afebrile cases, and previous possible cause of infection (otitis, sinusitis, odontogenic infection, etc.) seem reasonable not only to have brain abscess but also be scheduled for neuroimaging with specialized modes.