MULTIPLE PYOGENIC BRAIN ABSCESSES

Thirty eight patients with multiple pyogenic brain abscesses constitut ed 11% of all the brain abscesses treated during a 12 year period. Six ty per cent (23) of the patients were in the first two decades of life , including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered ''sensorium'' at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease ( 18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus wa s required as a life saving measure, to control raised intracranial pr essure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admi ssion was the most significant factor affecting the outcome. Surgery h as a definite therapeutic and life saving role in the management of mu ltiple pyogenic brain abscesses. A systematic treatment plan for multi ple abscesses is proposed.