Brain Abscess and Subdural Empyema — WACS Viva & Clinical Scenarios (Central Nervous System Infections and Infestations)

Exam-style brain abscess and subdural empyema viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old male presents with a 2-week history of worsening right frontal headache, low-grade fever, and progressive left hemiparesis following an untreated frontal sinusitis episode. Contrast-enhanced cranial CT shows a 3.5 cm rim-enhancing hypodense mass in the right frontal lobe with extensive perilesional vasogenic oedema and a 7 mm midline shift. Outline your initial diagnostic workup, timing of surgical intervention, operative approach, and empirical antimicrobial regimen.
• SCENARIO 2: Discuss the pathological progression of intracranial brain abscesses from early cerebritis to late capsule formation. Explain how the radiological characteristics on MRI diffusion-weighted imaging (DWI) and contrast-enhanced sequences correlate with each histological stage, and state the definitive neurosurgical management principles for each phase.
• SCENARIO 3: A 16-year-old female with chronic suppurative otitis media develops acute altered consciousness, neck stiffness, high-grade fever, and right-sided focal seizures. Cranial MRI reveals a crescentic extra-axial fluid collection along the left cerebral convexity and falx cerebri that restricts on DWI, with prominent leptomeningeal enhancement. Detail the immediate emergency resuscitation, surgical strategy, potential intracranial vascular complications, and definitive multidisciplinary management.
• SCENARIO 4: Compare and contrast stereotactic aspiration versus open craniotomy with capsule excision for the surgical treatment of encapsulated supratentorial and infratentorial brain abscesses, specifying the absolute and relative indications, contraindications, and anatomical determinants for each technique.
• SCENARIO 5: Detail the clinical, radiological, and microbiological distinctions between a ring-enhancing high-grade glial neoplasm and an encapsulated pyogenic brain abscess, including the role of MR spectroscopy and advanced neuroimaging modalities.