Elsevier

Surgical Neurology

Volume 63, Issue 5, May 2005, Pages 442-449
Surgical Neurology

Infection
Brain abscess: clinical experience and analysis of prognostic factors

https://doi.org/10.1016/j.surneu.2004.08.093Get rights and content

Abstract

Background

Over the past 2 decades, the diagnosis and treatment of brain abscess have been facilitated by a number of technological advancements, which have resulted in a significant improvement of outcome. The aim of this manuscript is to review our experience, to determine the factors related to the outcome, and to improve the therapeutic strategy for this disease.

Methods

From 1986 to 2002, 178 consecutive patients with bacterial brain abscess were treated at the National Taiwan University Hospital, Taipei, Taiwan. We reviewed their clinical presentation, bacteriology, treatment, and outcome retrospectively. Groups were compared by χ2 test, Fisher exact test, or t test as appropriate. Multivariate logistic regression with backward selection was used to select the set of covariates that were independently associated with outcome.

Results

One hundred eleven patients (62%) had favorable outcome, 14 patients (8%) had severe disability, 9 patients (5%) became vegetative, and 44 (25%) died during hospitalization. Patients with better Glasgow Coma Scale (GCS) on admission, no underlying disease, positive culture, or surgical treatment were more likely to have a good outcome. Patients with nasopharyngeal carcinoma, acquired immunodeficiency syndrome, hematologic disease, deep-seated abscess, or medical treatment alone were more likely to have a poor outcome. Multivariate analysis revealed that only GCS, immunodeficiency, and presence of underlying disease related with outcome.

Conclusions

The poor prognostic factors of brain abscess are poor GCS, immunodeficiency, and presence of underlying disease. Aggressive treatment with surgery when indicated and careful management of specimen for culture might improve outcome.

Introduction

With the availability of computed tomography (CT), more effective antibiotics, and improved surgical techniques, the mortality from brain abscess decreased to less than 10% in the 1990s [12], [22], [25], and from 30% to 60% in the early 1970s [1], [17], [18]. Despite the significant reduction in mortality, brain abscess remains a serious illness that can result in severe disability or even death, especially if misdiagnosed or managed improperly [4].

Tseng et al [24] reviewed 26 cases of brain abscess in our institution from 1983 to 1986. However, during the past years, there have been changes in the epidemiology of this condition, and the management has become increasingly complicated [12]. The purpose of this study was to delineate the clinical, biologic, and therapeutic factors influencing the outcome of brain abscess and to improve the treatment strategy by reviewing the cases diagnosed at our institution after Tseng's study.

Section snippets

Patients and methods

We retrospectively analyzed the medical records of patients with brain abscess treated at the National Taiwan University Hospital over the period of 17 years (1986-2002). This hospital is a major university-affiliated teaching hospital in northern Taiwan. The total number of patients in the database from which patients with brain abscesses were abstracted was around 757 000. The final diagnosis of brain abscess was established when cranial CT or magnetic resonance images (MRIs) showed localized

Clinical manifestations

The 178 patients included 130 males and 48 females. Their ages ranged from 2 months to 84 years (mean, 43 ± 21 years). Mostly were adults aged 20 to 60 years (60%), but there were also 16 cases (9%) younger than 10 years.

The mean duration of symptoms before diagnosis of brain abscess was 11 days (range, 1-60 days). There were 19 patients (11%) who had duration of symptoms longer than 4 weeks. Most of them had poorly defined neurological deficits. The longest duration, 60 days, occurred on a

Discussion

The outcome was poor in 38% of our patients, with an overall mortality of 25%. These figures seem worse than those reported earlier. The mortality was around 10% in several series reported before 2000 [21], [22], [25] and was between 17% and 32% in series reported after 2000 [7], [8], [10], [16]. This discrepancy may be mainly due to the drastic changes in epidemiology taking place nowadays. It does not necessarily mean differences in quality of care. Compared to the previous report from our

Conclusions

The independent factors influencing outcome of brain abscesses were initial GCS, immunodeficiency, and presence of underlying disease. Aggressive treatment with surgery when indicated and careful management of specimen for culture might improve the outcome.

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