Which symptom is most typical of an intracranial abscess?

• A. Chronic cough and hoarseness.
• B. Headache on the side of the abscess unrelieved by analgesics.
• C. Hearing loss with tinnitus.
• D. Progressive lower extremity weakness.

Answer: (B)

Unilateral, localized headache is the hallmark presentation of an intracranial abscess. The abscess creates mass effect and inflammation that irritates the meninges and raises intracranial pressure, so the pain tends to be severe, focused on the side of the lesion, and often not relieved by ordinary analgesics. Fever and focal neurologic signs may accompany it, but the key clue here is the persistent, side-specific headache.

The other symptoms listed don’t fit as well: chronic cough with hoarseness suggests airway or laryngeal disease; hearing loss with tinnitus points to inner ear or CN VIII pathology; and progressive weakness in the legs could arise from many conditions but isn’t the classic hallmark of a brain abscess.