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Brain abscesses in Northern Ireland: a 30 year community review
Abstract:
One hundred and seventy-two cases of intracranial abscesses, obtained from Neurosurgical and Centralised Autopsy Records for Northern Ireland for the 30 years, 1947--1976, have been reviewed. The incidence of the disease has fallen from five to three per million of population per year over the past three decades. Intracranial abscesses were three times as common in males as in females. Twenty-nine per cent of the abscesses were in the temporal lobe, 25% frontal, 10% parietal, 6% cerebellar, 3% occipital, and 7% were either subdural or in deep sites such as the thalamus; the remainder (20%) were multiple. Multiple and occipital abscesses were all fatal, temporal and parietal abscesses were associated with a 65% mortality, and 45% of patients with frontal abscesses died. Chronic suppurative otitis media was the single largest cause, and it was the only aetiological factor to have shown a progressive decline over 30 years. For those seen and treated in the neurosurgical unit the mortality was 53%, but if those obtained from the necropsy records were included the overall mortality was 70%.
Insights
Incidence of intracranial abscesses declined over 30 years, with males more affected. Chronic suppurative otitis media was the primary cause, and overall mortality remained high.
Area of Science:
- Neurology
- Neurosurgery
- Epidemiology
Background:
- Intracranial abscesses represent a significant neurological challenge.
- Understanding historical trends and etiological factors is crucial for public health.
Purpose of the Study:
- To review 172 cases of intracranial abscesses over 30 years (1947-1976).
- To analyze incidence, demographics, localization, causes, and mortality rates.
Main Methods:
- Retrospective review of neurosurgical and autopsy records from Northern Ireland.
- Data analysis of case incidence, patient sex, abscess location, etiology, and outcomes.
Main Results:
- Incidence decreased from 5 to 3 per million annually.
- Abscesses were more common in males (3:1 ratio).
- Temporal and frontal lobes were most frequently affected; multiple and occipital abscesses had 100% mortality.
- Chronic suppurative otitis media was the leading cause, showing a decline.
- Overall mortality was 70%, but 53% for treated cases.
Conclusions:
- Intracranial abscess incidence has declined, but remains a serious condition.
- Chronic suppurative otitis media is a key preventable cause.
- Prompt neurosurgical intervention improves survival, but mortality remains substantial.