Decreased mortality from brain abscesses since advent of computerized tomography

Restricted access

✓ No deaths have occurred among 20 consecutive patients with intraparenchymal brain abscesses treated at the University of California, San Francisco, since computerized tomographic (CT) brain scanning became a routine diagnostic procedure (study period: July, 1974, to June, 1977). These patients have been compared to 18 consecutive cases treated without benefit of CT analysis (January, 1970, to June, 1974) in order to determine the factors responsible for the recently improved prognosis. The mortality rate was 44% for all cases and 36% for all operated patients treated before the availability of CT. Similar morbidity (about 33%) was seen in survivors from both series. No significant differences in the two groups were noted with respect to patient population and antibiotic or corticosteroid therapy. Among the factors that may have contributed to the improved results for patients diagnosed with CT are: less frequent occurrence of multiple abscesses, fewer patients with poor preoperative clinical status, and a greater incidence of total abscess removal. In addition, CT scanning provided more accurate diagnosis and localization of abscesses and aided in the rapid detection of postoperative complications that probably accounted for six out of eight deaths in the earlier series. Serial CT studies provide a means to optimize the timing for surgical intervention and plan appropriate medical therapy. It is note-worthy that two patients have been followed by serial CT scans to non-surgical cures.

Article Information

Contributor Notes

Address reprint requests to: The Editorial Office, Department of Neurological Surgery, University of California, 350 Parnassus Avenue, Suite 807, San Francisco, California 94143.
Headings
References
  • 1.

    Beller AJSahor APraiss I: Brain abscess — review of 89 cases over a period of 30 years. J Neurol Neurosurg Psychiatry 36:7577681973Beller AJ Sahor A Praiss I: Brain abscess — review of 89 cases over a period of 30 years. J Neurol Neurosurg Psychiatry 36:757–768 1973

    • Search Google Scholar
    • Export Citation
  • 2.

    Black P: Brain abscess in Kagan BM (ed): Antimicrobial Therapy. Philadelphia: WB Saunders1970 pp 244252Black P: Brain abscess in Kagan BM (ed): Antimicrobial Therapy. Philadelphia: WB Saunders 1970 pp 244–252

    • Search Google Scholar
    • Export Citation
  • 3.

    Black PGraybill JRCharache P: Penetration of brain abscess by systemically administered antibiotics. J Neurosurg 38:7057091973Black P Graybill JR Charache P: Penetration of brain abscess by systemically administered antibiotics. J Neurosurg 38:705–709 1973

    • Search Google Scholar
    • Export Citation
  • 4.

    Brewer NSMacCarty CSWellman WE: Brain abscess: a review of recent experience. Ann Intern Med 82:5715761975Brewer NS MacCarty CS Wellman WE: Brain abscess: a review of recent experience. Ann Intern Med 82:571–576 1975

    • Search Google Scholar
    • Export Citation
  • 5.

    Carey MEChou SNFrench LA: Experience with brain abscesses. J Neurosurg 36:191972Carey ME Chou SN French LA: Experience with brain abscesses. J Neurosurg 36:1–9 1972

    • Search Google Scholar
    • Export Citation
  • 6.

    Garfield J: Management of supratentorial intracranial abscess. A review of 200 cases. Br Med J 2:7111969Garfield J: Management of supratentorial intracranial abscess. A review of 200 cases. Br Med J 2:7–11 1969

    • Search Google Scholar
    • Export Citation
  • 7.

    Heineman HSBraude AIOsterholm JL: Intracranial suppurative disease. Early presumptive diagnosis and successful treatment without surgery. JAMA 218:154215471971Heineman HS Braude AI Osterholm JL: Intracranial suppurative disease. Early presumptive diagnosis and successful treatment without surgery. JAMA 218:1542–1547 1971

    • Search Google Scholar
    • Export Citation
  • 8.

    Joubert MJStephanov S: Computerized tomography and surgical treatment in intracranial suppuration. Report of 30 consecutive unselected cases of brain abscess and subdural empyema. J Neurosurg 47:73781977Joubert MJ Stephanov S: Computerized tomography and surgical treatment in intracranial suppuration. Report of 30 consecutive unselected cases of brain abscess and subdural empyema. J Neurosurg 47:73–78 1977

    • Search Google Scholar
    • Export Citation
  • 9.

    Kiser JLKendig JH: Intracranial suppuration. A review of 139 consecutive cases with electron-microscopic observations on three. J Neurosurg 20:4945111963Kiser JL Kendig JH: Intracranial suppuration. A review of 139 consecutive cases with electron-microscopic observations on three. J Neurosurg 20:494–511 1963

    • Search Google Scholar
    • Export Citation
  • 10.

    Kramer PWGriffith RSCampbell RL: Antibiotic penetration of the brain. A comparative study. J Neurosurg 31:2953021969Kramer PW Griffith RS Campbell RL: Antibiotic penetration of the brain. A comparative study. J Neurosurg 31:295–302 1969

    • Search Google Scholar
    • Export Citation
  • 11.

    Krayenbühl HA: Abscess of the brain. Clin Neurosurg 14:25441967Krayenbühl HA: Abscess of the brain. Clin Neurosurg 14:25–44 1967

    • Search Google Scholar
    • Export Citation
  • 12.

    Le Beau JCreissard PHarispe Let al: Surgical treatment of brain abscess and subdural empyema. J Neurosurg 38:1982031973Le Beau J Creissard P Harispe L et al: Surgical treatment of brain abscess and subdural empyema. J Neurosurg 38:198–203 1973

    • Search Google Scholar
    • Export Citation
  • 13.

    Levison ME: The importance of anaerobic bacteria in infectious diseases. Med Clin North Am 57(4):101510271973Levison ME: The importance of anaerobic bacteria in infectious diseases. Med Clin North Am 57 (4):1015–1027 1973

    • Search Google Scholar
    • Export Citation
  • 14.

    Messina AVGuido LJLiebeskind AL: Preoperative diagnosis of brain-stem abscess by computerized tomography with survival. Case report. J Neurosurg 47:1061081977Messina AV Guido LJ Liebeskind AL: Preoperative diagnosis of brain-stem abscess by computerized tomography with survival. Case report. J Neurosurg 47:106–108 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    Morgan HWood MWMurphey F: Experience with 88 consecutive cases of brain abscess. J Neurosurg 38:6987041973Morgan H Wood MW Murphey F: Experience with 88 consecutive cases of brain abscess. J Neurosurg 38:698–704 1973

    • Search Google Scholar
    • Export Citation
  • 16.

    New PFJDavis KRBallantine HT Jr: Computed tomography in cerebral abscess. Radiology 121:6416461976New PFJ Davis KR Ballantine HT Jr: Computed tomography in cerebral abscess. Radiology 121:641–646 1976

    • Search Google Scholar
    • Export Citation
  • 17.

    Samson DSClark K: A current review of brain abscess. Am J Med 54:2012101973Samson DS Clark K: A current review of brain abscess. Am J Med 54:201–210 1973

    • Search Google Scholar
    • Export Citation
  • 18.

    Shaw MDMRussell JA: Value of computed tomography in the diagnosis of intracranial abscess. J Neurol Neurosurg Psychiatry 40:2142201972Shaw MDM Russell JA: Value of computed tomography in the diagnosis of intracranial abscess. J Neurol Neurosurg Psychiatry 40:214–220 1972

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 231 210 7
Full Text Views 282 116 0
PDF Downloads 101 28 0
EPUB Downloads 0 0 0
PubMed
Google Scholar