[Bacterial brain abscess].
The most common symptom of brain abscesses are headache, nausea, fever, disturbance of consciousness, focal signs and seizures. CT is the most useful investigation, showing ring-enhancing lesions with perifocal edema. Systemic inflammatory signs, cerebrospinal fluid changes and cerebral enhancement on leukocyte scintigraphy are of limited diagnostic value. In 10-20% of cases, diagnosis can only be established by biopsy. The most frequent organisms are aerobic streptococci, anaerobes, gram-negative bacilli and staphylococci. Metronidazole in combination with a third-generation cephalosporin and--in certain cases--an antistaphylococcal antibiotic should be given for at least 4 weeks. Conservative treatment can give satisfactory results in abscesses less than 2-3 cm in diameter. Medium-sized and deep-seated abscesses are treated by CT-guided stereotactic aspiration. In very large abscesses with the risk of herniation craniotomy and excision are necessary. Mortality is nowadays 5-15% and does not depend on treatment modalities. Prognosis is mainly determined by the patient's level of consciousness on admission.
Schielke
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Neurologische Universittsklinik der Charité, Humboldt-Universität zu Berlin.
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D003399:Craniotomy; D004322:Drainage; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate
D000900:Anti-Bacterial Agents