Diagnosis and Management of Brain Abscess

Osenbach, Richard K.; Loftus, Christopher M.

doi:10.1016/s1042-3680(18)30671-5

Cited by 118 publications

(66 citation statements)

References 65 publications

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“…Mixed infections that are particularly common in abscesses are those that have an otogenic or mastoid origin. 33 In their multicenter study, de Louvois et al 9 found that cultures were positive for bacteria grown in 100% of brain abscesses even in the face of antimicrobial treatment. Nevertheless, the rate of negative results for cultures of abscess material can be as high as 34%.…”

Section: Laboratory Studiesmentioning

confidence: 99%

“…21 The patient must be followed up closely clinically and radiologically when a brain abscess is managed medically. 33 If there is no clinical or radiological improvement despite appropriate medical treatment, surgical treatment should be seriously considered. 44 …”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

“…William Macewen was the first to make a major contribution to the management of brain abscesses; he diagnosed and proposed surgical treatment for a brain abscess in 1876. 5,33 In his classic work, Pyogenic Infectious Disease of the Brain and Spinal Cord. Meningitis, Abscess of the Brain, Infective Sinus Thrombosis, 28 published in 1893, he advised draining the abscess and treating the underlying causative sinus infections.…”

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confidence: 99%

“…13,27 During the treatment period, regular weekly CT examination is advised, followed by monthly CT after discontinuation of antibiotic therapy until the complete resolution of the abscess. 33 An immediate CT scan should be done if any deterioration is detected in a patient's status or if no clinical improvement is achieved despite a full course of appropriate therapy (Fig. 2).…”

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confidence: 99%

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Management of bacterial brain abscesses

Hakan

2008

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✓ Brain abscesses are well-known lesions that have been reported from the beginning of the Hippocratic era. They continue, however, to be characterized by problematic and fatal features, even though there have been enormous developments in treatment and diagnostic technologies—especially in the areas of computed tomography (CT), surgery, anesthesia, bacterial isolation techniques, and new antibiotics. The predisposing factors may change according to patient age, geographic location, and socioeconomic conditions of the community, but patients frequently have a contiguous infection such as otitis or mastoiditis. The clinical signs and symptoms of brain abscesses are nonspecific. Patients typically present with signs and symptoms due to mass effects, accompanied by high fever and seizure. The main treatment is surgical, although medical therapy can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or free hand, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. The success of the treatment, whether surgical or medical, mostly depends on the success of isolation of the causative organism, which provides essential data for accurate medical treatment. Third-generation cephalosporins and metronidazole are the most commonly used antimicrobial agents in the treatment of brain abscesses. Use of corticosteroids may be acceptable when lesions are accompanied by edema. Prophylactic antiepileptic therapy is strongly recommended. The patient's Glasgow Coma Scale score at presentation is one of the most important factors predicting outcome.

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Section: Laboratory Studiesmentioning

confidence: 99%

Section: Antimicrobial Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Management of bacterial brain abscesses

Hakan

2008

FOC

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“…Therefore surgical intervention is essential once the capsule is formed. [17][18][19][20] Hence brain abscess following CSOM can be effectively managed if evolution pattern is known, as the treatment is mainly based on the stage of abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Otogenic brain abscess and its management with review of literature

Melkundi¹,

Melkundi

2017

Int J Otorhinolaryngol Head Neck Surg

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INTRODUCTIONOtogenic brain abscess is a relatively common problem in developing countries, where the prevalence of chronic suppurative otitis media (CSOM) is reported to be in the range of 30-40% and 0.5%-1% of developing brain abscess. The most commonly encountered intracranial complication is meningitis followed by brain abscess. The mortality of the brain abscess is in the range of 30-40%. 1 The eradication of infection in the brain and the ear is a major challenge which was realized as early as 1893 by Sir Williams Macewan, who described mastoid approach to both the abscesses. However with the development of otology and neurosurgery as separate entities, otologists started relying on neurosurgeons for the intracranial abscess removal followed by mastoidectomy. 2Hence the standard treatment for otogenic brain abscess evolved in two separate procedures addressing primary focus in mastoid its secondary complications in the brain, each with its own surgical mortality and morbidity. 3,4 Chronic otitis media with cholesteatoma and/or granulation tissue are usually the cause. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. The first line of treatment is antibiotic, followed immediately by surgical evacuation of the abscess and cleansing the sources of infection.6 CT-scanning is the best available diagnostic tool. 1Due to improvement in the surgical and anesthesia techniques, recently the advantages of eradicating the ABSTRACT Background: Proper management of chronic otitis media may reduce the incidence of otogenic brain abscess. The objective of this study is to present our experience in the management of otogenic brain abscess by neurosurgical and otolaryngological surgery simultaneously. Methods: It is a retrospective study conducted between 2006-2015. 20 patients with otogenic brain abscess were admitted to neurosurgery and ENT wards for management were included in the study. On admissions patients had ENT, neurosurgery and neurological examinations. All the patients underwent neurosurgery followed by mastoidectomy. Repeat CT scanning/ MRI scanning done after 1 week to check for the success of the surgery and discharged on the 10th day after suture removal. Patients were followed up for 1-2 years. Results: The study included sixteen males and four females. Their age ranged between 4-32 years with mean of 18 years. Their chief complaints were severe headache, vomiting and fever with unilateral and or bilateral foul smelling discharge. Brain and HRCT temporal bone CT scanning showed equal incidence of abscess on the sides with 8 cerebellar, 6 temporal, 5 tempero parietal and 1 fronto parietal abscess. After completion of surgery, eighteen patients improved and two patents expired due to septic shock. Conclusions: This is technically more feasible technique with an added advantage of single anaesthesia, short stay of patient in the hospital and early disease clearance in the same procedure.

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