Brain abscess: a review of 400 cases

The author reviews 400 cases of brain abscess treated in China over 20 years. The commonest cause was chronic ear infection, with abscesses in the temporal lobe and cerebellum. Signs of increased intracranial pressure were present in most cases, localizing neurological signs in two-thirds, and clinical signs of infection in only 57%. The difficulties of early diagnosis may be considerable. Definitive diagnosis was dictated by the techniques available: when clinical features and ultrasound indicated a localized abscess, a burr hole and exploratory aspiration were used; otherwise, and in complicated cases, angiography or ventriculography were required. Antibiotics were given in full doses for an extended period. Aspiration was the initial treatment in 253 cases, with 22% mortality. Excision was the sole treatment in 128 patients, of whom 17.2% died. A further 76 patients underwent aspiration followed by excision; 25% of these patients died. There was no significant difference in mortality in these treatment groups. The most important predictor of outcome was the patient's condition when first seen. In 103 cases, signs of brain herniation were present; the mortality was 64% in these patients. In the 297 without herniation, mortality was only 8.4%. Early referral for specialist care, computerized tomography, correct choice and dosage of antibiotics, and the surgical methods in present use should make this a benign disease.