Acute Cerebellar Abscess: Report of a Case

Abstract

The unusual opportunity recently occurred to observe the complete course of a cerebellar abscess in a hospitalized patient from the onset of otitis media, which caused the abscess, to recovery following drainage. The clinical history of this case is reported because it is highly instructive in its bearing on the treatment of the condition.According to Eagleton,1 the average mortality from abscess of the brain is still high, 75 per cent or more. The statistics of Coleman,2 however, who obtained nineteen recoveries in twenty-eight cases (a mortality of only 31 per cent), suggests that the average number of deaths is unnecessarily high. Faunce and Shambaugh 3 more recently reported six consecutive cases with only one death.The usual high mortality from abscess of the brain is in part due to failure to make a timely diagnosis. Eagleton 1 emphasized that the literature is filled with reports of cases in which a diagnosis of abscess of the brain was not made "because of the absence of symptoms of brain abscess," whereas a careful review of the cases would show that in reality the symptoms were present and that if they had been properly interpreted the correct diagnosis could have been made.The possibility of the presence of an abscess of the brain should always be thought of when cerebral symptoms develop during or shortly after otitis media, paranasal sinusitis, abscess of the lung or bronchiectasis. The initial symptoms of cerebral suppuration are usually mild, consisting of slight fever, headache and vomiting. Localizing neurologic changes appear only as the abscess becomes well developed, and the symptoms and signs of cerebral compression may not appear until shortly before death. While delay in operative intervention is advantageous in the early stages of abscess of the brain, delay of even a day in the later stages may be fatal.