Brain AbscessesL

Abstract

The clinical features and. results of treatment of 99 cases of surgically or pathologically verified brain abscesses studied in a 16-year period between 1940 and 1956 were reviewed. The age of the patients ranged from 9 days to 68 years with a higher frequency in older age groups than previously reported. An unexplained preponderance of males was noted. An unusually high incidence (26%) of these cases occurred without evidence of previous infection, and a high proportion (24 cases) of the abscesses were sterile. Pneumococcus declined in frequency since 1944 with a relative increase in the frequency of Streptococcus viridans since that time. The clinical course from the time of the primary infection to the 1st symptom of intracranial involvement was found to range from 2 months to over 20 years. Once neurologic symptoms developed, however, the course of the patient was rapidly downhill. The initial temperature and pulse rate recordings were of little value in indicating the presence of the suppurative process. The white blood count and erythrocyte sedimentation rate, however, were elevated in 2/3 and 3/4 of the cases, respectively. Spinal fluid cell count was normal in 29% of the cases, and protein elevated in 80% of examinations, emphasizing the difficulty in the differential diagnosis of brain abscess from other mass intracranial lesions. The average surgical mortality in this series was 37% with successively better operative results in later years, corresponding to the widespread usage of sulfa drugs, penicillin, and later broad-spectrum antibiotics. The best results were obtained with a combination of sulfa, penicillin and broad-spectrum drugs. The most favorable operative procedure was excision; aspiration, however, was most frequently employed. Abscesses secondary to lung suppuration had a 62% mortality, while cases secondary to mastoid infection had a 50% mortality. Sinus infection, as the primary infection, had the most favorable result (17% mortality).