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studied by Glasgow outcome scale (GOS). Patients in accordance with the therapeutic response and
with evidence of neurological symptoms unrelated to neuroimaging findings.
brain abscess were excluded from the study as, there
was evidence showing the patient had not undergone Low-dose corticosteroid was used to manage
a drainage procedure or intraoperative pus sampling perilesional edema in first 5-7 days. Seizure prophylaxis
and the patient was lost to follow-up within the first or antiepileptic medication was applied in all cases and
year after operation. continued for at least 2 years.

Patients with features of suspected brain abscess were Surgical intervention
undergone preoperative computed tomography (CT) Burr hole aspiration was performed under local or
and/or magnetic resonance imaging (MRI) scans with general anesthesia for abscesses larger than 2.5 cm,
contrast enhancement. The normal CT scan of brain signs of brain herniation secondary to space-occupying
finding was hypodense lesion with thick contrast lesions (SOL) or ventricular proximity, abscess growth
enhancing capsule with surrounding edema. By during medical therapy or SOL of uncertain etiology
conventional MRI, pyogenic brain abscesses were associated with neurological deterioration. If the
identified by hypointense signal in T1-weighted and size of the abscess on CT or MRI obtained after the
hyperintense signal in T2-weighted, with ring-shaped first aspiration increased or was not reduced despite
enhancement and extensive surrounding edema. antibiotic therapy, aspiration was repeated. During
Conventional MRI with diffusion-weighted imaging, surgical procedure, the abscess was drained completely
and magnetic resonance spectroscopy (MRS) were and rinsed with saline containing gentamycin until
performed when it was difficult to discriminate brain the effluent was clear. Patients with poor response
abscesses from cystic or necrotic tumors in our later to repeated aspirations (with three aspirations) and
cases of the series. MRS spectra in patients with medical treatment underwent complete excision
abscess showed lactate, amino acids (including valine, of abscesses through open craniotomy excision.
alanine, and leucine), and acetate peaks while spectra Postoperative abscesses where burr hole aspiration
for patients with cystic or necrotic tumors showed would hinder the fusion of the bone flap also underwent
only lactate peaks. Hyperintensity was detected in complete abscess excision through open craniotomy
all the pyogenic abscess cavities, and hypointensity excision. Patients with otomastoiditis and brain abscess
was observed in all the cystic and necrotic tumors on underwent radical mastoidectomy in a same time or
diffusion-weighted images. A predisposing factor was the second session.
considered as any conditions or events which were
directly related to the onset of a brain abscess. The RESULTS
neurological status at admission was evaluated using
the Glasgow coma scale (GCS) and the outcome of the Of 221 cases of clinico-radiologically diagnosed brain
patients was assessed using the GOS on discharge and abscess, 162 cases were surgically managed. Types of
12 months after the operation. Chi-square test was abscess [Table 1], predisposing factors [Table 2], site
done to see the association between GCS on admission of abscess [Table 3] and types of operations, residual
and mortality in brain abscess. Standard laboratory neuro-deficit and outcome [Table 4] are shown.
tests including a complete blood count, erythrocyte
sedimentation rate (ESR), C-reactive protein, blood One hundred and thirteen cases were acute pyogenic
cultures, and serum chemistry were conducted in abscess [Figures 1-4] and 49 were chronic abscess. Among
all cases. Case findings were based on the review the chronic abscess, 29 were chronic pyogenic abscess, 14
of microbiology laboratory data for all intracranial were tubercular [Figures 5 and 6], 3 aspergillus [Figure 7]
samples. All collected intracranial pus with or without and 3 abscesses were in malignant brain metastases.
abscess wall samples were transported promptly
to laboratory microscopy, aerobic, anaerobic and Age range was 3-72 (average 42.5) years. The
fungal culture and sensitivity and histopathological male-to-female ratio in our study was 3.37:1. Gender
study. Initial empirical antimicrobial therapies were
selected in accordance with the portal of entry and the Table 1: Types of abscess
Number of
Acute
anatomical location of the abscess. Initial empirical Types of different type of Chronic pyogenic Total
brain
chronic
antimicrobial therapy included a combination of abscess chronic abscess abscess (%) abscess (%)
high dose of ceftriaxone/cefuroxime/meropenam, Chronic 29 49 (30.24) 113 (69.76) 162
flucloxacillin/vancomycin and metronidazole. Between pyogenic
4 and 6 days later, treatment either remained the same Tubercular 14
3
Aspergillus
or was changed based on the results of antimicrobial Abscess in 3
sensitivity. Antibiotic therapy lasted for 4-8 weeks metastases

154 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 155