Lumbar puncture procedure, which is performed in many infectious disorders of the central nervous system is contraindicated in this condition (as it is in all space-occupying lesions of the brain) because removing a certain portion of the cerebrospinal fluid may alter the concrete intracranial pressure balances and causes the brain tissue to move across structures within the skull (brain herniation).Ring enhancement may also be observed in cerebral hemorrhages (bleeding) and some brain tumors. However, in the presence of the rapidly progressive course with fever, focal neurologic findings (hemiparesis, aphasia etc.) and signs of increased intracranial pressure, the most likely diagnosis should be the brain abscess. Treatment
The treatment includes lowering the increased intracranial pressure and starting intravenous antibiotics (and meanwhile identifying the causative organism mainly by blood culture studies).Hyperbaric oxygen therapy (HBO2 or HBOT) is indicated as a primary and adjunct treatment which provides four primary functions. Firstly, HBOT reduces intracranial pressure. Secondly, high partial pressures of oxygen act as a bactericide and thus inhibits the anaerobic and functionally anaerobic flora common in brain abscess. Third, HBOT optimizes the immune function thus enhancing the host defense mechanisms and fourth, HBOT has been found to be of benefit when brain abscess is concomitant with cranial osteomyelitis. Secondary functions of HBOT include increased stem cell production and up-regulation of VEGF which aid in the healing and recovery process.Surgical drainage of the abscess remains part of the standard management of bacterial brain abscesses.
The location and treatment of the primary lesion also crucial, as is the removal of any foreign material (bone, dirt, bullets, and so forth). There are few exceptions to this rule: Haemophilus influenzae meningitis is often associated with subdural effusions that are mistaken for subdural empyemas. These effusions resolve with antibiotics and require no surgical treatment. Tuberculosis can produce brain abscesses that look identical to conventional bacterial abscesses on CT imaging. Surgical drainage or aspiration is often necessary to identify Mycobacterium tuberculosis, but once the diagnosis is made no further surgical intervention is necessary. CT guided stereotactic aspiration is also indicated in the treatment of brain abscess. The use of pre-operative imaging, intervention with post-operative clinical and biochemical monitoring used to manage brain abscesses today dates back to the Pennybacker system pioneered by Somerset, Kentucky-born neurosurgeon Joseph Buford Pennybacker, director of the neurosurgery department of the Radcliffe Infirmary, Oxford from 1952 to 1971. Prognosis
While death occurs in about 10% of cases, people do well about 70% of the time. This is a large improvement from the 1960s due to improved ability to image the head, more effective neurosurgery and more effective antibiotics. References
External links

Brain abscess at eMedicine
MR Diagnosis MedPix Imaging Brain Abscess