Brain Abscess Follow-up

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 5, 2012
 

Further Inpatient Care

  • Most abscesses are managed with intravenous antibiotic therapy to enable the organization of the lesion and to reduce local extension of the infection. After that period, definitive treatment consists of aspiration, incision and drainage, or excision.
  • Currently, nonoperative approaches (ie, prolonged courses of parenteral antibiotics) are rarely used. An exception is an abscess at an inoperable site. Such cases are uncommon, as many abscesses that were once inoperable can now be reached by stereotactic aspiration guided by precision mapping of the lesion's location with CT or MRI. Magnetic resonance fluoroscopy is used to guide aspiration instead of stereotactic aspiration.
Next

Complications

Permanent neurological damage may include hemiparesis, cranial nerve palsy, hydrocephalus, intellectual and behavioral disorders, ataxia, spasticity, visual defects, and optic atrophy. Recurrent seizures develop in about 10-30% of survivors.

Previous
Next

Prognosis

Mortality has declined since the introduction of CT and MRI and the development of newer surgical techniques. Mortality rate is about 15%. The mortality is higher in immunocompromised, those who had a transplant, and those with brain stem or deep hemispheric abscesses.

A poorer prognosis is associated with a delayed diagnosis or a misdiagnosis, severe mental status changes at the time of diagnosis, rapid progression of the infection and neurological impairment, multiple and deep abscesses, ventricular rupture, the presence of coma or stupor at diagnosis, inadequate treatment, and specific organisms (ie, Aspergillus species, other fungi, Pseudomonas species).

Previous
Next

Patient Education

Previous
 
Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey D Band, MD  Professor of Medicine, Oakland University William Beaumont School of Medicine; Director, Division of Infectious Diseases and International Medicine, Corporate Epidemiologist, William Beaumont Hospital; Clinical Professor of Medicine, Wayne State University School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Levy RM. Brain abscess and subdural empyema. Curr Opin Neurol. Jun 1994;7(3):223-8. [Medline].

  2. Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. Oct 1997;25(4):763-79; quiz 780-1. [Medline].

  3. Brook I, Friedman EM. Intracranial complications of sinusitis in children. A sequela of periapical abscess. Ann Otol Rhinol Laryngol. Jan-Feb 1982;91(1 Pt 1):41-3. [Medline].

  4. Glickstein JS, Chandra RK, Thompson JW. Intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg. May 2006;134(5):733-6. [Medline].

  5. Brook I. Microbiology and antimicrobial treatment of orbital and intracranial complications of sinusitis in children and their management. Int J Pediatr Otorhinolaryngol. Sep 2009;73(9):1183-6. [Medline].

  6. Migirov L, Duvdevani S, Kronenberg J. Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol. Aug 2005;125(8):819-22. [Medline].

  7. Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. Jan 2007;26(1):1-11. [Medline].

  8. Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transpl Infect Dis. Sep 2000;2(3):101-11. [Medline].

  9. Tunkel AR, Pradhan SK. Central nervous system infections in injection drug users. Infect Dis Clin North Am. Sep 2002;16(3):589-605. [Medline].

  10. Bensalem MK, Berger JR. HIV and the central nervous system. Compr Ther. Spring 2002;28(1):23-33. [Medline].

  11. Tseng JH, Tseng MY. Brain abscess in 142 patients: factors influencing outcome and mortality. Surg Neurol. Jun 2006;65(6):557-62; discussion 562. [Medline].

  12. Brook I. Brain abscess in children: microbiology and management. J Child Neurol. Jul 1995;10(4):283-8. [Medline].

  13. Brook I. Microbiology of intracranial abscesses and their associated sinusitis. Arch Otolaryngol Head Neck Surg. Nov 2005;131(11):1017-9. [Medline].

  14. Finegold SM. Anaerobic Bacteria in Human Disease. New York, NY: Academic Press; 1977.

  15. Schwartz S, Thiel E. Update on the treatment of cerebral aspergillosis. Ann Hematol. 2004;83 Suppl 1:S42-4. [Medline].

  16. Naesens R, Ronsyn M, Druwe P, et al. Central nervous system invasion by community-acquired meticillin-resistant Staphylococcus aureus. J Med Microbiol. Sep 2009;58(Pt 9):1247-51. [Medline].

  17. Le Moal G, Landron C, Grollier G, et al. Characteristics of brain abscess with isolation of anaerobic bacteria. Scand J Infect Dis. 2003;35(5):318-21. [Medline].

  18. Tsou TP, Lee PI, Lu CY, et al. Microbiology and epidemiology of brain abscess and subdural empyema in a medical center: a 10-year experience. J Microbiol Immunol Infect. Oct 2009;42(5):405-12. [Medline].

  19. Kranick SM, Vinnard C, Kolson DL. Propionibacterium acnes brain abscess appearing 10 years after neurosurgery. Arch Neurol. Jun 2009;66(6):793-5. [Medline].

  20. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics. Jun 2004;113(6):1765-70. [Medline].

  21. Swartz MN, Karchmer AE. Balow's infections of the central nervous system. In: Anaerobic Bacteria: Role in Disease. Springfield: CC Thomas; 1974:309-25.

  22. Sanchez-Portocarrero J, Perez-Cecilia E, Corral O, et al. The central nervous system and infection by Candida species. Diagn Microbiol Infect Dis. Jul 2000;37(3):169-79. [Medline].

  23. Erdogan E, Beyzadeoglu M, Arpaci F, Celasun B. Cerebellar aspergillosis: case report and literature review. Neurosurgery. Apr 2002;50(4):874-6; discussion 876-7. [Medline].

  24. Al Masalma M, Lonjon M, Richet H, Dufour H, Roche PH, Drancourt M, et al. Metagenomic analysis of brain abscesses identifies specific bacterial associations. Clin Infect Dis. Jan 2012;54(2):202-10. [Medline].

  25. Bernardini GL. Diagnosis and management of brain abscess and subdural empyema. Curr Neurol Neurosci Rep. Nov 2004;4(6):448-56. [Medline].

  26. Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011;9(2):136-44. [Medline].

  27. Brook I. The importance of lactic acid levels in body fluids in the detection of bacterial infections. Rev Infect Dis. May-Jun 1981;3(3):470-8. [Medline].

  28. Nguyen JB, Black BR, Leimkuehler MM, et al. Intracranial pyogenic abscess: imaging diagnosis utilizing recent advances in computed tomography and magnetic resonance imaging. Crit Rev Comput Tomogr. 2004;45(3):181-224. [Medline].

  29. Sener RN. Diffusion MRI findings in neonatal brain abscess. J Neuroradiol. Jan 2004;31(1):69-71. [Medline].

  30. Leuthardt EC, Wippold FJ 2nd, Oswood MC, et al. Diffusion-weighted MR imaging in the preoperative assessment of brain abscesses. Surg Neurol. Dec 2002;58(6):395-402; discussion 402. [Medline].

  31. Britt RH, Enzmann DR. Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic, neuropathological, and clinical correlations. J Neurosurg. Dec 1983;59(6):972-89. [Medline].

  32. Yogev R, Bar-Meir M. Management of brain abscesses in children. Pediatr Infect Dis J. Feb 2004;23(2):157-9. [Medline].

  33. Nakajima H, Iwai Y, Yamanaka K, et al. Successful treatment of brainstem abscess with stereotactic aspiration. Surg Neurol. Nov 1999;52(5):445-8. [Medline].

  34. Honda H, Warren DK. Central nervous system infections: meningitis and brain abscess. Infect Dis Clin North Am. Sep 2009;23(3):609-23. [Medline].

  35. Livraghi S, Melancia JP, Antunes JL. The management of brain abscesses. Adv Tech Stand Neurosurg. 2003;28:285-313. [Medline].

  36. Barling RW, Selkon JB. The penetration of antibiotics into cerebrospinal fluid and brain tissue. J Antimicrob Chemother. May 1978;4(3):203-27. [Medline].

  37. Stephanov S. Surgical treatment of brain abscess. Neurosurgery. Apr 1988;22(4):724-30. [Medline].

  38. Tattevin P, Bruneel F, Clair B, et al. Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999). Am J Med. Aug 1 2003;115(2):143-6. [Medline].

 
Previous
Next
 
CT scan of a brain abscess.
MRI of a brain abscess.
Brain abscess.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.