Observations on brain abscess. Review of 28 cases

Twenty-eight cases of intracranial abscess managed at the Alfred Hospital, Melbourne, over ten years are reviewed. In half the cases, a brain abscess was a complication of paracranial infection. In one-third of the cases, infection arose from distant spread, usually from the heart. The temporal lobe was the most common site. While neither the site nor the source of infection was a consistent prognostic factor, the patient's level of consciousness at the time of operation was considered significant. Mortality was lowest in those with the least disturbance of consciousness. The best results were obtained with excision, though this was usually only appropriate in chronic cases. The total mortality rate was 10 deaths in 28 patients (36%), and the operative mortality rate was eight deaths in 26 patients (31%). The lethal nature of brain abscess, despite recent advances in diagnosis and treatment, is emphasised.