Decadron in the treatment of cerebral abscess

An experimental study

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✓ Forty rabbits were inoculated with Streptococcus pyogenes or Staphylococcus aureus to produce cerebral abscesses. One-third of the rabbits received no treatment and served as controls. One-third received dexamethasone (Decadron) plus an appropriate antibiotic. One-third received only the appropriate antibiotic in the same dosage. The animals were sacrificed 10 days after inoculation and the brains examined. In the control group, an abscess at the stage of granulation tissue encapsulation containing the inoculated organisms was found. The surrounding brain showed a marked inflammatory response. In the Decadron plus antibiotic group, necrotic lesions were found containing the inoculated organisms and surrounded by relatively normal brain. In the group treated with antibiotic alone, healed glial scars were found in relatively normal brain. Our findings are discussed with reference to the medical literature regarding the influence of glucocorticoids on the inflammatory response and the efficacy of antibiotics when this response is suppressed.

Article Information

Address reprint requests to: Jane Anne Johnston, M.B., F.R.C.S. (C), Department of Neurosurgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N OW8.

© AANS, except where prohibited by US copyright law.

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Figures

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    Rabbit in control group. Upper Left: Whole brain shows large cerebral herniation. Lower Left: Cross section of brain shows abscess cavity. Right: Photomicrograph of coronal slice shows abscess cavity at the top. A thick peripheral zone of granulomatous tissue with extensive capillary proliferation, condensation of circumferential fibers within the capsule, and infiltration by inflammatory cells of all types is seen. The tissue reaction spreads through the entire thickness of the overlying cortex and there is perivascular inflammatory infiltration. H & E, × 50. Inset: Chains of streptococci are seen in the abscess cavity. Gram stain, × 500.

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    Rabbit from group receiving Decadron and penicillin. Upper Left: Whole brain exhibits a slight herniation. Lower Left: Cross section shows a round necrotic lesion. Right: Photomicrograph of coronal slice shows a necrotic lesion (below) with discernible unresolved dead nerve cells, normal brain tissue (above), and a narrow zone between the two in which only slight capillary reaction and a few inflammatory cells are found. H & E, × 50. Inset: Streptococcal microorganisms are seen in the necrotic masses. Gram stain, × 600.

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    Rabbit from group treated with penicillin alone. Upper Left: Whole brain shows slight herniation. Lower Left: Cross section shows healed lesion. Right: Photomicrograph of coronal slice shows healed lesion with fragments of agar (above) provoking foreign body giant cell reaction. No definite tissue proliferation is seen, but there is gliosis in the border zone with otherwise normal brain tissue. H & E, × 50.

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