title: Management outcome of NPC-related and non-NPC-related brain abscess in Hong Kong.
abstract: OBJECTIVE
  (1) To review the patient profile, management outcome and prognostic factors of brain abscess; (2) To compare the neurological outcome of nasopharyngeal carcinoma (NPC)-related brain abscess with non-NPC related brain abscess.
  
  
  METHODS
  Retrospective review of consecutive patients diagnosed (radiologically and/or microbiologically) with brain abscess in a regional neurosurgical center in Hong Kong over a nine year period.
  
  
  RESULTS
  Fifty-four patients were recruited into this study. There were 37 male and 17 female patients. Eighteen (33%) patients had previous radiotherapy for nasopharyngeal carcinoma. Only 31 (57%) patients had fever on presentation. White cell count and/or C-reactive protein, was raised in 41 (76%) patients on admission. Surgical drainage was carried out in 49 (91%) patients, either by aspiration through a craniotomy, by drainage with corticotomy, or excision of the abscess. Abscess culture was positive in 45 (83%) patients. Common organisms isolated included Streptococcus species (35%) and Peptostreptococcus species (18%). Anaerobes were isolated in 50% of the NPC-related abscesses. The mean follow-up time was 34 months. At the 6 months interval, 24 (44%) patients had good recovery. Favorable outcome was achieved in 30 (55%) patients. NPC-related brain abscess was associated with unfavorable neurological outcome (33%, p = 0.04). There was also a trend towards higher in-patient mortality in patients with NPC-related brain abscess (22%, p = 0.08).
  
  
  CONCLUSIONS
  Brain abscess carried a substantial morbidity and mortality despite aggressive surgical and medical treatment. Patients with NPC-related brain abscess had a higher mortality and unfavorable neurological outcome.
authors.affiliation: Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Mandy Ho-Man
authors.initials: MH
authors.lastname: Tam
authors.forename: George Kwok-Chu
authors.initials: GK
authors.lastname: Wong
authors.forename: Margaret
authors.initials: M
authors.lastname: Ip
authors.forename: Michael Koon Ming
authors.initials: MK
authors.lastname: Kam
authors.forename: Jill Morales
authors.initials: JM
authors.lastname: Abrigo
authors.forename: Xian Lun
authors.initials: XL
authors.lastname: Zhu
authors.forename: Wai Sang
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000209:etiology* / Q000401:mortality / Q000532:radiotherapy; D002097:C-Reactive Protein / Q000032:analysis; D019090:Case Management; D002494:Central Nervous System Infections / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000401:mortality / Q000532:radiotherapy; D009336:Necrosis; D009422:Nervous System Diseases / Q000209:etiology / Q000523:psychology; D019635:Neurosurgical Procedures; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein