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Multiple pyogenic brain abscesses

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Summary

Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants.

The clinical presentation was similar to brain abscess in general. 21 patients had altered “sensorium” at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%).

The abscesses were invariably large in size.

The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients.

Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule.

The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome.

Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.

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References

  1. Alderson D, Strong AJ, Ingham HR, Selkon JB (1981) Fifteen year review of mortality of brain abscess. Neurosurgery 8: 1–5

    PubMed  Google Scholar 

  2. Ayyagari A, Pancholi VK, Kak VK, Kumar N, Khosla VK, Agrawal KC, Gulati DR (1983) Bacteriological spectrum of brain abscess with special reference to anaerobic bacteria. Ind J Med Res 77: 182–186

    Google Scholar 

  3. Ayyagari A, Pancholi VK, Kak VK, Kumar N, Khosla VK, Agarwal KC, Gulati DR (1985) Role of anaerobes and chemotherapy in brain abscess. Ind J Pathol Microbiol 28: 1–6

    Google Scholar 

  4. Barsoum AH, Lewis HC, Cannillo KL (1981) Non-operative treatment of multiple brain abscess. Surg Neurol 16: 283–287

    PubMed  Google Scholar 

  5. Basit AS, Bhatia R, Banerji AK, Tandon PN (1989) Multiple pyogenic brain abscesses: an analysis of 21 patients. J Neurol Neurosurg Psychiatry 52: 591–594

    PubMed  Google Scholar 

  6. Bellar AJ, Sahar A, Praiss I (1973) Brain abscess: a review of 89 cases over a period of 30 years. J Neurol Neurosurg Psychiatry 36: 757–768

    PubMed  Google Scholar 

  7. Bhatia R, Tandon PN, Banerji AK (1973) Brain abscess — an analysis of 55 cases. Internat Surg 58: 565–568

    Google Scholar 

  8. Bidzuiski J, Koszewski W (1990) The value of different methods of treatment of brain abscess in the CT era. Acta Neurochir (Wien) 105: 117–120

    Google Scholar 

  9. Boom WH, Tuazon C (1985) Successful treatment of multiple brain abscesses with antibiotics alone. Rev Infect Dis 7: 189–199

    PubMed  Google Scholar 

  10. Britt RH (1985) Brain abscess. In: Wilkins RH, Rengachari SS (eds) Neurosurgery, Vol 3. McGraw-Hill, New York, pp 1928–1956

    Google Scholar 

  11. Burke LP, Ho SH, Cerullo LJ, Kim KS, Harter DH (1981) Multiple brain abscesses. Surg Neurol 16: 452–454

    PubMed  Google Scholar 

  12. Carey ME, Chou SN, French LA (1972) Experience with brain abscesses. J Neurosurg 36: 1–9

    PubMed  Google Scholar 

  13. Chakravorty RN, Bidwai PS, Vak VK, Banerjee AK, Khattri HN, Sapru RP, Walia BNS, Kumar L, Suri S, Wahi PL (1989) Brain abscess in congenital cyanotic heart disease. Ind Heart J 41: 190–193

    Google Scholar 

  14. Choudhury AR, Taylor JC, Whitaker R (1977) Primary excision of brain abscess. BMJ 2: 1119–1121

    PubMed  Google Scholar 

  15. Danzinger A, Prie H, Schecker MM (1980) An analysis of 113 intracranial infections. Neuroradiology 19: 31–34

    PubMed  Google Scholar 

  16. de Louvois J (1978) Bacteriology of chemotherapy of brain abscess. J Antimicrob Chem 4: 395–413

    PubMed  Google Scholar 

  17. de Louvois J (1980) Bacteriological examination of pus from abscess of the CNS. J Clin Pathol 33: 66–71

    PubMed  Google Scholar 

  18. de Louvois J, Gortvai P, Hurley R (1977) Bacteriology of the abscess of the central nervous system: a multicentre prospective study. BMJ 2: 981–984

    PubMed  Google Scholar 

  19. Dharker SR, Shadangi TM, Vaishya ND, Arora VK, Dharker RS (1978) Pyogenic brain abscess — experience with 87 cases. Neurology (India) 26: 126–130

    Google Scholar 

  20. Dohrmann PJ, Elrick WL (1982) Observations on brain abscess: review of 28 cases. Med J Aust 2: 81–83

    PubMed  Google Scholar 

  21. Dyste GN, Hitchon PW, Menezes AH, VanGilder JC, Greene GM (1988) Stereotaxic surgery in the treatment of multiple brain abscesses. J Neurosurg 69: 188–194

    PubMed  Google Scholar 

  22. Garfield J (1969) Management of supratentorial intracranial abscess: a review of 200 cases. BMJ 2: 7–11

    PubMed  Google Scholar 

  23. George B (1981) Antibiotic therapy for multiple brain abscess (letter). J Neurosurg 55: 153–154

    Google Scholar 

  24. Holtas S, Tornquist C, Cronquist S (1982) Diagnostic difficulties in computed tomography of brain abscesses. J Comput Assist Tomogr 6: 683–688

    PubMed  Google Scholar 

  25. Joubert MJ, Stephanov S (1977) Computerized tomography and surgical treatment in intracranial suppuration: report of 30 consecutive unselected cases of brain abscess and subdural empyema. J Neurosurg 47: 73–78

    PubMed  Google Scholar 

  26. Kagawa M, Takeshita M, Yato S, Kitamaura K (1983) Brain abscess in congenital cyanotic heart disease. J Neurosurg 58: 913–917

    PubMed  Google Scholar 

  27. Karandanis D, Shulman JA (1975) Factors associated with mortality in brain abscess. Arch Intern Med 135: 1145–1150

    PubMed  Google Scholar 

  28. Keet PC (1990) Cranial intradural abscess. Management of 641 patients during the 35 years from 1952 to 1986. Br J Neurosurg 4: 273–278

    PubMed  Google Scholar 

  29. Kiser JL, Kendig JH (1963) Intracranial suppuration. A review of 139 consecutive cases with electron microscopic observation of three. J Neurosurg 20: 494–511

    PubMed  Google Scholar 

  30. Kobrine AI, Davis DO, Rizzoli HV (1981) Multiple abscesses of the brain. Case report. J Neurosurg 54: 93–97

    PubMed  Google Scholar 

  31. Koszewskiw M (1991) Epilepsy following brain abscess. The evaluation of possible risk factors with emphasis on new concepts of epileptic focus formation. Acta Neurochir (Wien) 113: 117–120

    Google Scholar 

  32. Kratimenos G, Crockard HA (1991) Multiple brain abscess: a review of fourteen cases. Br J Neurosurg 5: 153–161

    PubMed  Google Scholar 

  33. Kulali A, Ozatik N, Topcer I (1990) Otogenic intracranial abscesses. Acta Neurochir (Wien) 107: 140–146

    Google Scholar 

  34. Mampalam JJ, Rosenblum M (1988) Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery 23: 451–458

    PubMed  Google Scholar 

  35. Maurice-Williams RS (1983) Open evacuation of pus: a satisfactory surgical approach to the problem of brain abscess. J Neurol Neurosurg Psychiatry 46: 697–703

    PubMed  Google Scholar 

  36. McClelland CJ, Craig BF, Crockard HA (1978) Brain abscesses in Northern Ireland: a 30 year community review. J Neurol Neurosurg Psychiatry 41: 1043–1047

    PubMed  Google Scholar 

  37. Miller E, Dias PS, Uttley D (1988) CT scanning in the management of intracranial abscess: a review of 100 cases. Br J Neurosurg 2: 439–446

    PubMed  Google Scholar 

  38. Morgan H, Wood MW, Murphey F (1973) Experience with 88 consecutive cases of brain abscesses. J Neurosurg 38: 698–704

    PubMed  Google Scholar 

  39. Nielsen H, Gyldensted C (1977) Computed tomography in the diagnosis of cerebral abscess. Neuroradiology 12: 207–217

    PubMed  Google Scholar 

  40. Nielen H, Glydensted C, Harmsen A (1982) Cerebral abscess: aetiology and pathogenesis, symptoms, diagnosis and treatment. A review of 200 cases from 1935–76. Acta Neurol Scand 65: 609–622

    PubMed  Google Scholar 

  41. Pathak A, Sharma BS, Mathuriya SN, Khosla VK, Khandelwal N, Kak VK (1990) Controversies in the management of subdural empyema. Acta Neurochir (Wien) 102: 25–32

    Google Scholar 

  42. Rosenblum ML, Hoff JT, Norman D, Weinstein PR, Pitts L (1978) Decreased mortality from brain abscess since advent of computed tomography. J Neurosurg 49: 658–668

    PubMed  Google Scholar 

  43. Rosenblum ML, Manpalam TJ, Pons VG (1986) Controversies in the management of brain abscesses. Clin Neurosurg 33: 603–632

    PubMed  Google Scholar 

  44. Rosenblum ML, Rosegeni H (1979) Resection of multiple nocardial brain abscesses: diagnostic role of computerized tomography. Neurosurgery 4: 315–318

    PubMed  Google Scholar 

  45. Rousseaux M, Lesoin F, Destee A (1985) Developments in the treatment and prognosis of multiple cerebral abscesses. Neurosurgery 16: 304–308

    PubMed  Google Scholar 

  46. Sharma BS, Kak VK (1980) Multiple subdural abscesses following colonic perforation — a rare complication of a ventriculoperitoneal shunt. Pediatr Radiol 18: 407–408

    Google Scholar 

  47. Stephanov S (1988) Surgical treatment of brain abscess. Neurosurgery 22: 724–730

    PubMed  Google Scholar 

  48. Stephanov S, Joubert MJ (1982) Large brain abscesses treated by aspiration alone. Surg Neurol 17: 338–340

    PubMed  Google Scholar 

  49. Tekkok IH, Erbengi A (1992) Management of brain abscess in children: review of 130 cases over a period of 21 years. Childs Nerv Syst 8: 411–416

    PubMed  Google Scholar 

  50. Theophilo F, Markakis E, Theophilo L (1985) Brain abscess in childhood. Childs Nerv Syst 1: 324–328

    PubMed  Google Scholar 

  51. Uttley D (1991) Multiple cerebral abscesses. Br J Neurosurg 5: 119–121

    PubMed  Google Scholar 

  52. Von Dellen JR (1987) Cerebellar abscess: the impact of computed tomographic scanning. Neurosurgery 2: 547–550

    Google Scholar 

  53. Westcombe DS, Dorsch NWC, Teo Ch (1988) Management of cerebral abscess in adolescents and adults. Experience in the CT scan era. Acta Neurochir (Wien) 95: 85–89

    Google Scholar 

  54. Yang SY (1981) Brain abscess: a review of 400 cases. J Neurosurg 55: 794–799

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    B. S. Sharma, V. K. Khosla, V. K. Kak, V. K. Gupta, M. K. Tewari, S. N. Mathuriya & A. Pathak

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  1. B. S. Sharma
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  2. V. K. Khosla
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  3. V. K. Kak
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  4. V. K. Gupta
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  6. S. N. Mathuriya
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Sharma, B.S., Khosla, V.K., Kak, V.K. et al. Multiple pyogenic brain abscesses. Acta neurochir 133, 36–43 (1995). https://doi.org/10.1007/BF01404945

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