title: Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients.
abstract: OBJECTIVE
  Brain abscess (BA) is a neurosurgical emergency and despite significant medical advances, it remains a surgical challenge. A single institution's two decade computed tomography era management experience with BA is reported.
  
  
  METHODS
  A retrospective analysis of patients with BA, admitted to the Department of Neurosurgery, Wentworth Hospital, Durban, KwaZulu-Natal, South Africa, was performed. The medical records were analyzed for demographic, clinical, neuroimaging, neurosurgical and otolaryngology management, microbiological characteristics, and their relationship to outcome.
  
  
  RESULTS
  During a 20-year period (1983-2002), 973 patients were treated. The mean age was 24.36 ± 15.1 years (range: 0.17-72 years) and 74.2% (n = 722) were men. The mean admission Glasgow Coma Score was 12.5 ± 2.83. The majority of BAs were supratentorial (n = 872, 89.6%). The causes were otorhinogenic (38.6%), traumatic (32.8%), pulmonary (7%), cryptogenic (4.6%), postsurgical (3.2%), meningitis (2.8%), cardiac (2.7%), and "other" (8.6%). Surgical drainage was performed in 97.1%, whereas 19 patients had nonoperative management. The incidence of BA decreased during the study period. Patient outcomes were good in 81.3% (n = 791), poor in 5.3% (n = 52), and death (13.4%, n = 130) at discharge. The management morbidity, which included postoperative seizures, was 24.9%. Predictors of mortality were cerebral infarction (odds ratio [OR] 31.1), ventriculitis (OR 12.9), coma (OR 6.8), hydrocephalus (OR 5.1), dilated pupils (OR 4.8), bilateral abscesses (OR 3.8), multiple abscesses (OR 3.4), HIV co-infection (OR 3.2), papilledema (OR 2.6), neurological deterioration (OR 2.4), and fever (OR 1.7).
  
  
  CONCLUSIONS
  Optimal management of BA involves surgical drainage for medium-to-large abscesses (≥2.5 cm) with simultaneous eradication of the primary source, treatment of associated hydrocephalus, and administration of high doses of intravenous antibiotics. The incidence of BA is directly related to poor socioeconomic conditions and therefore, still poses a public health challenge in developing countries.
authors.affiliation: Department of Neurosurgery, Wentworth Hospital and University of KwaZulu-Natal, KwaZulu-Natal, South Africa. nathoon@cox.net
authors.forename: Narendra
authors.initials: N
authors.lastname: Nathoo
authors.forename: Sameer S
authors.initials: SS
authors.lastname: Nadvi
authors.forename: Pradeep K
authors.initials: PK
authors.lastname: Narotam
authors.forename: James R
authors.initials: JR
authors.lastname: van Dellen
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000150:complications; D001922:Brain Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery*; D002526:Cerebellar Diseases / Q000473:pathology / Q000601:surgery; D002648:Child; D002781:Cholesteatoma / Q000150:complications / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications; D004322:Drainage; D005334:Fever / Q000209:etiology; D015600:Glasgow Coma Scale; D015658:HIV Infections / Q000150:complications; D020197:Head Injuries, Penetrating / Q000150:complications; D006261:Headache / Q000209:etiology; D006801:Humans; D009127:Muscle Rigidity / Q000209:etiology; D019635:Neurosurgical Procedures; D010346:Patient Care Management; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013019:South Africa; D013238:Stereotaxic Techniques; D017216:Telemedicine; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome