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Multiple pyogenic brain abscesses
B S Sharma1, V K Khosla, V K Kak
1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Multiple pyogenic brain abscesses are rare, often affecting young patients. Surgical intervention, including aspiration and excision, is crucial for managing intracranial pressure and improving patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Multiple pyogenic brain abscesses represent 11% of all brain abscess cases.
- The majority of patients (60%) were under 20 years old, including infants.
Purpose of the Study:
- To analyze the clinical presentation, management, and outcomes of multiple pyogenic brain abscesses.
- To propose a systematic treatment plan for this condition.
Main Methods:
- Retrospective analysis of 38 patients with multiple pyogenic brain abscesses over 12 years.
- Evaluation of clinical data, causative organisms, surgical interventions, and mortality rates.
Main Results:
- Otogenic abscesses (26%) and congenital cyanotic heart disease (18%) were common associations.
- Staphylococcus aureus was the most frequent organism (24%); 29% of pus cultures were sterile.
- Aspiration was necessary in 76% of cases to control intracranial pressure; 32% underwent secondary excision.
- Overall mortality was 32%, with uncontrolled infection being the primary cause.
- Admission consciousness level significantly impacted outcomes.
Conclusions:
- Surgery plays a vital therapeutic and life-saving role in managing multiple pyogenic brain abscesses.
- A structured treatment approach is essential for optimizing patient survival and recovery.
Abstract:
Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered "sensorium" at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome. Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.