A Retrospective Analysis on the Prognostic Factors of Brain Abscess

ABSTRACT

The medical records of fifty-seven patients uith intracranial abscess which had been admitted to the departrnents of neurology, neurosurgery, otolaryngology and pediatrics. In Seoul National University Hospital from 1983 to 1992 were reviewed. Mean age was 31.4 years, ranging from 3 to 66 vears. Male predominated with the ratio of 2.6: 1. Common predisposing conditions were hearrt disease, parameningeal infection such as chronic otitis media, paranasal sinusitis, pulmonary infections in order of frequency. Primary focus was not determined in 16% of cases. A wide range of organisms were encountered and aerobes were more frequently cultivated than anaerobes. In 56% of cases. Pathogens were not confirmed. The use of preoperative antibiotics was not significantly correlated with sterile cultures: Initial symptoms and signs uere usually nonspecific; headache in 89%, fever in 53%. Nausea and vomiting in 54%. Altered consciousness in 39%. Computed tomography was the most accurate and rapid diagnostic tool, and serial follow-up during the treatment was helpful in knowing whether the response to several treatment modalities was good or not. Of the fifty-seven cases, twenty-seven patients were operated; 17 patients underwent aspiration of the abscesses, and ten patients received resection of abscesses. Sixty three percents of surviving patients suffered from neurologic sequelae; most commonly epilepsy in 50%. The mortality rate among all treated patients was significantly related to the initial consciousness level and the number ol the abscesses, but not to the size ol lesion. Identification of organism, age or sex. Although non-surgical therapy is appropriate n some selected patients, surgical intervention should be considered, when the consciousness level deterates or the CT findings are aggravated after full dose of combination antibiotics.