Skip to main content


Log in

Clinical characteristics and course of primary brain abscess

  • Original Article - Infection
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript



Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions.


We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes.


The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%.


One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others


  1. al. RNe (2016) S1-Leitlinie Hirnabszess. Accessed 05 May 2018

  2. Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR (2013) Brain abscess: current management. J Neurosci Rural Pract 4:S67–S81

    PubMed  PubMed Central  Google Scholar 

  3. Amornpojnimman T, Korathanakhun P (2018) Predictors of clinical outcomes among patients with brain abscess in Thailand. J Clin Neurosci 53:135–139

    Article  PubMed  Google Scholar 

  4. Arends JE, Stemerding AM, Vorst SP, de Neeling AJ, Weersink AJ (2011) First report of a brain abscess caused by Nocardia veterana. J Clin Microbiol 49:4364–4365

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Bartek J Jr, Jakola AS, Skyrman S, Forander P, Alpkvist P, Schechtmann G, Glimaker M, Larsson A, Lind F, Mathiesen T (2016) Hyperbaric oxygen therapy in spontaneous brain abscess patients: a population-based comparative cohort study. Acta Neurochir 158:1259–1267

    Article  PubMed  Google Scholar 

  6. Bilic I, Petri NM, Krstulja M, Vuckovic M, Salamunic I, Kraljevic KS, Capkun V, Lusic I (2012) Hyperbaric oxygen is effective in early stage of healing of experimental brain abscess in rats. Neurol Res 34:931–936

    Article  PubMed  Google Scholar 

  7. Brook I (2017) Microbiology and treatment of brain abscess. J Clin Neurosci 38:8–12

    Article  PubMed  Google Scholar 

  8. Brouwer MC, Coutinho JM, van de Beek D (2014) Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology 82:806–813

    Article  PubMed  Google Scholar 

  9. Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D (2014) Brain abscess. N Engl J Med 371:447–456

    Article  PubMed  CAS  Google Scholar 

  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  11. de Louvois J, Gortavai P, Hurley R (1977) Bacteriology of abscesses of the central nervous system: a multicentre prospective study. Br Med J 2:981–984

    Article  PubMed  PubMed Central  Google Scholar 

  12. Helweg-Larsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J (2012) Pyogenic brain abscess, a 15 year survey. BMC Infect Dis 12:332–332

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hwang CS, Lee H, Hong MP, Kim JH, Kim KS (2018) Brain abscess caused by chronic invasive actinomycosis in the nasopharynx: a case report and literature review. Medicine 97:e0406

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kabre A, Zabsonre S, Diallo O, Cisse R (2014) Management of brain abscesses in era of computed tomography in sub-Saharan Africa: a review of 112 cases. Neuro-Chirurgie 60:249–253

    Article  PubMed  CAS  Google Scholar 

  15. Khan S, Kumar A, Kale S, Kurkure N, Nair G, Dinesh K (2018) Multiple cortical brain abscesses due to Listeria monocytogenes in an immunocompetent patient. Trop Dr 48:160–163

    Google Scholar 

  16. Landriel F, Ajler P, Hem S, Bendersky D, Goldschmidt E, Garategui L, Vecchi E, Konsol O, Carrizo A (2012) Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes--a 10-year single-center study. Acta Neurochir 154:903–911

    Article  PubMed  Google Scholar 

  17. Luo J, Wang X, Yang Y, Lan T, Ashraf MA, Mao Q (2016) Successful treatment of cerebral aspergillosis in a patient with acquired immune deficiency syndrome. West Indian Med J 64:540–542

    PubMed Central  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  19. Manor Y, Garfunkel AA (2018) Brain abscess following dental implant placement via crestal sinus lift - a case report. Eur J Oral Implantol 11:113–117

    PubMed  Google Scholar 

  20. Mathisen GE, Johnson JP (1997) Brain abscess. Clin Infect Dis 25:763–779 quiz 780–761

    Article  PubMed  CAS  Google Scholar 

  21. Nakahara K, Yamashita S, Ideo K, Shindo S, Suga T, Ueda A, Honda S, Hirahara T, Watanabe M, Yamashita T, Maeda Y, Yonemochi Y, Takita T, Ando Y (2014) Drastic therapy for listerial brain abscess involving combined hyperbaric oxygen therapy and antimicrobial agents. J Clin Neurol (Seoul, Korea) 10:358–362

    Article  Google Scholar 

  22. Nathoo N, Nadvi SS, Narotam PK, van Dellen JR (2011) Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg 75:716–726 discussion 612–717

    Article  PubMed  Google Scholar 

  23. Noguchi T, Okada N, Tsuchiya Y, Sarukawa S, Fujita A, Nishino H, Jinbu Y, Mori Y (2018) Management of a brain abscess presumably caused by radiation osteomyelitis of the mandible. J Craniofac Surg 29:e18–e20

    PubMed  Google Scholar 

  24. Ong CT, Tsai CF, Wong YS, Chen SC (2017) Epidemiology of brain abscess in Taiwan: a 14-year population-based cohort study. PLoS One 12:e0176705

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Pardeshi SK, Shetty A, Kulkarni A, Shah V (2017) Brain abscess drainage in a case of uncorrected tetralogy of Fallot under scalp block and dexmedetomidine. J Neurosurg Anesthesiol 29:362–363

    Article  PubMed  Google Scholar 

  26. Patel K, Clifford DB (2014) Bacterial brain abscess. Neurohospitalist 4:196–204

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schliamser SE, Backman K, Norrby SR (1988) Intracranial abscesses in adults: an analysis of 54 consecutive cases. Scand J Infect Dis 20:1–9

    PubMed  CAS  Google Scholar 

  28. Sherbuk J, Saly D, Barakat L, Ogbuagu O (2016) Unusual presentation of disseminated Nocardia abscessus infection in a patient with AIDS. BMJ Case Rep 2016:bcr-2016-215649

    Article  Google Scholar 

  29. Stefaniak J (2015) HIV/AIDS presenting with stroke-like features caused by cerebral Nocardia abscesses: a case report. BMC Neurol 15:183

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sweeney J, Bodman A, Hall WA (2018) Brain abscess of basal ganglia presenting with persistent hiccups. World Neurosurg 112:182–185

    Article  PubMed  Google Scholar 

  31. Tonon E, Scotton PG, Gallucci M, Vaglia A (2006) Brain abscess: clinical aspects of 100 patients. Int J Infect Dis 10:103–109

    Article  PubMed  Google Scholar 

  32. World-Medical-Association (2013) Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama 310:2191–2194

    Article  CAS  Google Scholar 

  33. Xiao F, Tseng MY, Teng LJ, Tseng HM, Tsai JC (2005) Brain abscess: clinical experience and analysis of prognostic factors. Surg Neurol 63:442–449 discussion 449–450

    Article  PubMed  Google Scholar 

  34. Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31:1116–1128

    Article  PubMed  Google Scholar 

  35. Zhang C, Hu L, Wu X, Hu G, Ding X, Lu Y (2014) A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China. BMC Infect Dis 14:311

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zhang Z, Cai X, Li J, Kang X, Wang H, Zhang L, Yan R, Gao N, Liu S, Yue S, Zhang J, Yang S, Yang X (2016) Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period. Acta Neurochir 158:733–739

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Nicole Lange.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Additional information

Data previously presented on EANS Congress (2017, Venice) as a lecture.

This article is part of the Topical Collection on Infection

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lange, N., Berndt, M., Jörger, AK. et al. Clinical characteristics and course of primary brain abscess. Acta Neurochir 160, 2055–2062 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: