title: Supratentorial deep-seated bacterial brain abscess in adults: clinical characteristics and therapeutic outcomes.
abstract: OBJECTIVE
  Supratentorial deep-seated bacterial brain abscess (BBA) in adults is rarely examined solely in the literature. This retrospective study is conducted to examine the clinical characteristics and therapeutic outcome of this specific group of BBA.
  
  
  METHODS
  Eight adult patients with supratentorial deep-seated BBA, collected during a study period of 14 years (1994-2007), were enrolled. Their microbiological data derived from cerebrospinal fluid (CSF), blood or pus cultures, clinical features and therapeutic outcome were analyzed.
  
  
  RESULTS
  The eight adult cases were six men and two women, aged 41 to 80 years (mean=61). Preceding medical conditions were found in five of these eight cases, while preceding neurosurgical event was found in one. Of the clinical presentations, hemiparesis (6) was the most common, followed by fever (5), altered consciousness (4), headache (3), septic shock (1), and seizure (1). The main locations of the BBA were the left basal ganglia in five, the left thalamus in two, and the right basal ganglia in one. Causative pathogens were found in six cases and the isolated pathogens were all cultured from CSF specimens. Positive bacteremia which grew K. pneumoniae was found in one case. Seven of these eight cases contracted the infection in a community-acquired state. Besides antibiotic treatment, seven of them received a neurosurgical intervention (stereotactic aspiration and/or ventriculoperitoneal shunt). The therapeutic result showed six cases survived and two expired. Five of the six survivors had variable degree of neurologic deficits.
  
  
  CONCLUSIONS
  Besides the common clinical features of BBA, supratentorial deep-seated BBA has a high incidence of hemiparesis in the early stages of disease. Most of the involved patients have community-acquired infections and are preceded by a medical condition. Stereotactic aspiration for therapeutic and diagnostic purposes, as well as shunting surgery, is the most common neuro-surgical procedures used for treatment. But despite therapeutic efforts, high mortality and morbidity remain.
authors.affiliation: Department of Neurology, Chang-Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Ya-Ting
authors.initials: YT
authors.lastname: Chang
authors.forename: Chen-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Ming-Jung
authors.initials: MJ
authors.lastname: Chuang
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Huang
authors.forename: Yao-Chung
authors.initials: YC
authors.lastname: Chuang
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Shu-Fang
authors.initials: SF
authors.lastname: Chen
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Chang
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000628:therapy*; D001922:Brain Abscess / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005682:Gadolinium