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Multiple brain abscess: a review of fourteen cases
1Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Abstract:
The case notes of 14 consecutive patients with multiple brain abscesses presenting over a 14 year period were studied with respect to the incidence and presentation, the source of infection, the investigations, microbiology and the treatment and outcome. The incidence of multiple brain abscesses in non-immunocompromised patients is 13% of all intracranial abscesses. Computerized tomographic scanning is vital both in the detection of multiple abscesses and in the subsequent assessment of therapy. The source of infection in half of our patients was the teeth or the paranasal sinuses. Streptococci were isolated in 63% of the patients; staphylococci in 21%. This has obvious implications for the antibiotic policy. Intracranial surgery, with few exceptions, had a diagnostic and management role rather than a curative one; identification of the causative organism was its prime purpose. CSF, obtained by lumbar punctures, did not provide any positive cultures and should not be contemplated in view of the inherent hazards. The elimination of the primary focus of infection was a most important step in the management of this condition. Multiple brain abscesses represent a potentially curable condition, provided appropriate antibiotics are used, the primary septic focus is eliminated and the intracranial complications are anticipated by the use of frequently repeated CT scans.
Insights
Multiple brain abscesses in non-immunocompromised patients are often linked to dental or sinus infections. Early detection with CT scans and targeted antibiotics are crucial for successful treatment and preventing complications.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Multiple brain abscesses are rare but serious intracranial infections.
- Understanding their epidemiology and sources is vital for effective management.
Purpose of the Study:
- To analyze the incidence, presentation, sources, investigations, microbiology, treatment, and outcomes of multiple brain abscesses in non-immunocompromised patients.
- To evaluate the role of diagnostic imaging and surgical interventions.
Main Methods:
- Retrospective case series analysis of 14 patients over 14 years.
- Review of patient records, including investigations, microbiology, and treatment protocols.
- Emphasis on the utility of computerized tomographic (CT) scanning.
Main Results:
- Multiple brain abscesses constitute 13% of intracranial abscesses in non-immunocompromised individuals.
- Common sources include dental and paranasal sinus infections.
- Streptococci (63%) and staphylococci (21%) were the predominant pathogens.
- CT scanning is essential for diagnosis and monitoring therapy.
- Surgery primarily served diagnostic and management purposes, not curative.
- Cerebrospinal fluid (CSF) cultures via lumbar puncture were unhelpful and hazardous.
Conclusions:
- Multiple brain abscesses are potentially curable with appropriate antibiotic therapy and elimination of the primary infection source.
- Aggressive monitoring with frequent CT scans is critical for managing intracranial complications.
- Lumbar puncture for CSF analysis is not recommended due to risks and low diagnostic yield.