Over the past 3 years, we have treated six carefully selected patients, diagnosed as having pyogenic brain abscesses, without surgical intervention. Two additional patients underwent surgery. All patients presented with the signs, symptoms, laboratory findings, and other diagnostic indications of a brain abscess. The diagnosis was established on the basis of characteristic computerized tomography (CT) findings.12,13,17 The CT scans* were performed before and after the administration of 300 ml of meglumine iothalamate (Conray 30) in adults, or of 0.5 gm/kg of iodine in children. All patients were either stable or improving during their early clinical course.
Patients were selected for prolonged antibiotic trial because of either medical conditions that increased the risks of surgery, or the presence of multiple abscesses, or lesions located in high-risk regions of the brain. A patient with improving clinical symptoms was included whose treatment was initiated in the cerebritis phase of abscess evolution and who showed early CT evidence of decreased abscess size. The disappearance of all signs of contrast enhancement and mass effect on CT scanning was considered an indication of abscess resolution.
Before advocating antibiotic therapy as a possible alternative to surgery in the treatment of selected patients with brain abscesses, it is essential to establish judicious guidelines for its use. Recent reports have not elucidated either indications for therapy or treatment guidelines.1,10,15,16 The evaluation of our eight patients provides a basis for determining such guidelines.
The authors wish to thank Susan Eastwood for editorial assistance in the preparation of this paper.
Black P: Personal communication1979
EMI Mark I 160 × 160 matrix scanner manufactured by EMI Tronics, Inc., 3605 Woodhead Drive, Northbrook, Illinois.
This work was supported in part by NIH Trauma Center Program Project Grant GM18470, and NIH Brain Edema Program Project Grant NS14543-01.