Brain abscess; epidemiology, clinical manifestations and management: A retrospective 5-year study

Infections involving the cerebrum are true neurosurgical emergency that require rapid diagnosis and appropriate surgical and medical intervention to achieve good clinical outcome. Brain abscess is one of most common forms of intracranial pyogenic infections. Bacterial infections of the nervous system are often challenging for the treating physician.Patients and In this study we evaluated 41 patients with brain abscess in Loghman hospital during 2002-2009. Demographic features, predisposing factors, clinical manifestations, laboratory data and managements were evaluated. Totally, 53.6% of patients were 15-29, 26% were 30-49 and 17% were 50-70 years old. The most frequently encountered clinical manifestations were headache (92.6%) and nausea and vomiting (73.1%). Predisposing condition leading to brain abscess were sinusitis (9.2%), otitis (12%), CSF rhinorrhea (2.4%), mastoiditis (7.2%), neurosurgery (17%) and endocarditis (2.4%), and finally 20% had no risk factor. Mean duration of disease was 13 days. For 80% of patients surgical intervention was performed. Mortality rate was 12%. A total of 9.7% of patients admitted with diagnosis of brain abscess were finally diagnosed as acute demyelinating encephalomyelitis (ADEM). In spite of improvement in diagnosis and treatment of patients with cerebral abscess, mortality is still high. Factors related to patient underlying diseases and the delay in commencement of antibiotic treatment were associated with increased mortality.