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Fifteen-year review of the mortality of brain abscess
Abstract:
Ninety consecutive cases of brain abscess admitted to this center between 1964 and 1978 have been reviewed. The overall mortality has fallen in three consecutive 5-year periods from 42 to 21 to 9.7%. A number of factors seem to be responsible for this. Early surgical intervention was associated with the reduction in mortality between the first and second 5-year periods. Recognition of the significance and extent of cerebral edema, confirmed since computed tomographic (CT) scans have been available, led to a greater use of steroids during the last 5-year period, but the number of patients thus treated was too small to permit an assessment of any effect on mortality. There is no evidence to suggest a change in the natural history of the disease, and surgical management has not altered significantly. Experience with CT scanning in this center in the diagnosis of brain abscess is limited. It is therefore not possible no assess whether any improvement in mortality may have arisen from the early and accurate diagnosis obtainable with this technique. Improvement in culture technique has been of major importance, leading to a better understanding of the bacteriology of brain abscesses. This has allowed a more rational antibiotic program to be instituted, in particular the use of agents active against obligate anaerobes.
Insights
Mortality from brain abscesses significantly decreased over three decades due to improved surgical timing and antibiotic strategies targeting anaerobic bacteria. Further research is needed to confirm the impact of advanced imaging techniques like CT scans.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Radiology
Background:
- Brain abscesses present a significant challenge in neurosurgery and infectious disease management.
- Historical data from 1964-1978 reveals trends in patient outcomes and treatment modalities.
Purpose of the Study:
- To review a consecutive series of brain abscess cases over a 14-year period.
- To identify factors contributing to changes in mortality rates.
- To evaluate the impact of evolving diagnostic and therapeutic approaches.
Main Methods:
- Retrospective review of 90 consecutive brain abscess cases.
- Analysis of mortality trends across three 5-year periods.
- Assessment of surgical intervention, cerebral edema management, and antibiotic therapy.
Main Results:
- Overall mortality decreased from 42% to 9.7% across the study periods.
- Early surgical intervention correlated with reduced mortality.
- Improved culture techniques led to better understanding of bacteriology and more targeted antibiotic use, including agents for obligate anaerobes.
Conclusions:
- Advances in surgical timing and antibiotic therapy, particularly against anaerobes, have significantly reduced brain abscess mortality.
- The role of computed tomography (CT) scanning in early diagnosis and its impact on mortality require further investigation.
- Steroid use for cerebral edema showed potential but requires larger studies for definitive conclusions.