BACTERIAL BRAIN-ABSCESS - A REVIEW OF 67 PATIENTS IN GERMANY

Sixty-seven patients with brain abscess were managed over 19 years (19 75 - 1993). Our series had a 2,5 to 1 male predominance; the age distr ibution was from 3 days to 81 years. The underlying conditions of hema togenic brain abscesses (n = 33; 49%) included lung infections (n = 16 ), heart disease (n = 4), sepsis (n = 10), and other foci (n = 3). Oto laryngologic infections led to the abscess in 10 cases; there were 9 t raumatic abscesses. The causes remained unknown in 15 cases. There wer e 47 solitary abscesses (70%) and 20 multiple abscesses. The most freq uent presenting signs and symptoms were neurologic deficits (n = 17), disturbances of consciousness (n = 14), seizures (n = 6), and headache s, meningism and vomiting (n = 13). Causative organisms were isolated in 39 cases (58%) and included staphylococci (n = 6), streptococci (n = 6), enterobacteriae (n = 2), and anaerobic pathogens (n = 9). The mo st reliable laboratory sign of inflammation was an elevated ESR (52/59 patients). With the advent of computed tomography, burr hole aspirati on of the abscess with or without drainage was possible in 30 cases; t he mortality in this subgroup was 9%. All 4 patients with surgical exc ision in the pre CT-era died. The mortality of patients treated with a ntibiotics only was 62% (18/29). Overall mortality was 37% (25/67), in cluding 5 cases with post mortem-diagnosis of brain abscess. Good reco very was achieved in 29/42 survivors. Predictors of a poor outcome wer e the patient's age, the level of consciousness, multiple abscesses, p olybacterial cultures, and a hematogenic etiology, but not the size of the abscess.