[Cerebral abscess in a general hospital. Analysis of 66 consecutive cases]

Analysis of the epidemiologic characteristics of cerebral abscesses and comparison with 2 therapeutic schedules.

The clinical history of 66 patients with cerebral abscesses admitted over 14 years in the Neurosurgical Ward of the Virgen de la Arrixaca Hospital in Murcia were reviewed. Two therapeutic groups were designed of 33 and 31 patients respectively treated with classical or modern schedules and clinical efficacy was evaluated.

Infections in the ORL area, craneoencephalic trauma, and brain surgery were the predisposing factors in 63% of the cases. The most frequent symptoms were migraine, fever, and alteration of consciousness in 75, 68 and 68% respectively. The most frequent locations were the temporal (36%), parietal (26%) and frontal lobes (23%). Microbiological studies were positive in 75% of the patients with the most frequent microorganisms being group A Streptococcus, Proteus mirabilis, Staphylococcus aureus and anaerobes. Mortality was 14%. Twenty-two percent of the patients had neurological sequelae. The rate of mortality was significantly associated to age greater than 40 years, fatal underlying disease, coma, initial clinical criteria and inadequate antibiotic treatment. The combination of cephotaxime-metronidazole was significantly associated to greater cure in comparison with the classical antibiotic combination although no significant differences were found in either the rate of mortality or relapse.

The combination of cephotaxime-metronidazole may constitute an interesting advance in the treatment of these processes. The epidemiological data obtained confirm those of larger series.