BRAIN-ABSCESS - CLINICAL AND MICROBIOLOGICAL STUDY AND PROGNOSTIC ANALYSIS OF 59 CASES

Introduction. Clinical, microbiological, therapeutic and prognostic ch aracteristics of brain abscesses were analyzed as well as the influenc e of CT in their evolution. Materials and methods. Retrospective study of 59 patients with the diagnosis of brain abscess of bacterial sourc e before (group A) and after (group B) the introduction of CT (25 and 34 patients, respectively). Results. The most common symptom was heada che (76.3%) and the most common abnormality in physical examination wa s a decrease in the level of consciousness (61%) and this abnormality was associated with a higher mortality rate (13% versus 41.6%; p<0.05) and also a higher proportion of neurologic sequelae (50% versus 85.7% ; p<0.05). The diagnosis was obtained earlier in group B. The hematoge nous source predominated (32.2%); an adjacent source was identified in 28.8% and an apparent source was not recognized in 27.2% (40% in grou p A versus 17.6% in group B), Anaerobic and microaerophilic streptococ ci were the bacteria recovered most frequently. Cram-negative aerobic bacteria were the most common in otogenic abscesses. The use of cortic osteroids had no influence upon mortality, but it was associated with a lower percentage of neurological sequelae (40% versus 14%; p<0.05), The introduction of CT decreased mortality (40% in group A versus 23.5 % in group B, although this difference was not significant) and also s equelae (86.6% in group A versus 57.6% in group B; p<0.05). Leaving ap art cases of bacterial endocarditis, in which death was due to the und erlying heart disease and a systemic sepsis picture, mortality attribu ted to brain abscess was 20.3%, Conclusions. The introduction of CT ha s meant a significant breakthrough for the diagnosis, treatment and fo llow-up of these patients and has contributed to improvement in surviv al. In our series, the diagnosis of brain abscess was obtained earlier and the number of brain abscesses with no apparent source has decreas ed since the introduction of CT. Moreover, CT sensitivity is really go od for locating multiple abscesses. Overall, the prognosis of these pa tients has improved since the introduction of this technique. Neverthe less, brain abscess is still associated with a relevant morbi-mortalit y rate.