Artikel
Management of spontaneous brain abscesses
Management spontaner Hirnabszesse
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Autoren
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Uwe Hassepaß
- Klinik für Neurochirurgie, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg
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V. Braun
- Klinik für Neurochirurgie, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg
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H.-P. Richter
- Klinik für Neurochirurgie, Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg
| Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Evaluation of important factors for an adequate therapy of spontaneous brain abscesses and propositions for future management.
Methods
Retrospective study, Haematogenous brain abscesses are rare. In our department they account for 0.1% of neurosurgical treated patients over the past ten years. 27 consecutive patients, 19 (70%) male and 8 (30%) female were included in this study. Data were analyzed with special interest on the outcome related to the microbiological behaviour and the time from onset of the first symptoms to the time of surgery.
Results
We observed one single lesion in 19 (70%), 2 abscesses in 3 (11%) and multiple distribution in 4 (15%) cases. The diameter of the abscesses ranged from 0.5 to 5.2 cm. The time from onset of first symptoms to operation ranged from 0 to 22 (mean=8) days. Empiric antibiotic medication started immediately in all cases. In 20 patients (74%) microbiological cultures were positive within 4 to 15 (mean=6.5) days. Streptococcus species were identified in 13 (48%) Fusobacterium and Norcardia in 2 (7%) each, Gemella morbillorum and Aspergillus in 1 case (4%) each. In 7 (26%) cases no pathologic agent could be found. 10 (37 %) abscesses were larger than 4 cm in diameter. 6 (60 %) were caused by streptococcus species, in three cases no bacteria were found due to prior antibiotic treatment, only one huge abscess was caused by fusobacterium naviforme. Follow-up is available for 21 (78%) patients over a period of 0-10 (mean=4,3) years. In the microbiological-positive group 3 (15%) patients died, 1 (5%) due to intractable brain edema and 2 (10%) as a result of accompanying diseases. 5 (25%) patients had a GOS of 4 and 9 (45%) of 5. In the microbiological-negative group 1 (14%) patient died, 1 (14%) had a moderate GOS of 4 and 3 (43%) had a good outcome with GOS of 5.
Conclusions
If a brain abscess is suspected, early surgery is important not only for a good clinical outcome, but also for the subsequent appropriate choice of antibiotics. The size of a cerebral brain abscess may hint at its origin. In our series Streptococcus species are a common cause for huge brain abscesses. An appropriate antibiotic regime should include this pathogen. Although the antimicrobiological therapy remains empiric in negative cultures, the outcome is not influenced significantly.
