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brain (11 cases), CSOM (22 cases), and congenital heart preoperative neuro-deficit was observed in 131 (80.86%)
disease (in 10 patients including 4 cases of Tetralogy cases [Figures 2-4]. Complete resolution of an abscess
of Fallot-TOF), infective endocarditis (3 cases), frontal with residual preoperative major neuro-deficit
sinusitis (12 cases), ethmoidal sinusitis (4 cases), was detected in 9 (5.55%) cases. Persistent major
and 3 patients were immunosuppressed or neuro-deficit was hemiparesis 1, motor dysphasia 1,
immunocompromised. hand weakness 1, foot drop 1, monoparesis 2, sensory
dysphasia 1, nominal dysphasia and visual field defect
Frontal lobe involved in 49 (30.2%) cases of brain 1. Coarse hemi-tremor resolved postoperatively along
abscess, temporal lobe is next to involved in 37 (22.8%) with abscess resolution. Mortality and morbidity with
cases. Parietal, occipital, cerebellar and gangliothalamic GCS at admission and GOS on last follow-up are
zone in 22 (13.6%), 24 (14.8%), 21 (21.96%) and shown in Table 7. Patients GCS on admission had
9 (5.5%) cases respectively. Site distributions of brain a significant effect on mortality in brain abscess as
abscess were shown in Table 3. shown in Table 8. Six patients with congenital heart
diseases underwent cardiac surgery; sinus surgery was
Operations used in brain abscess surgery were single performed in 12 patients and 5 patients underwent
time burr hole aspiration in 111 (68.5%) cases, two mastoidectomy in a different sitting within 1 year after
or more times burr hole aspiration in 34 (21%) cases, brain abscess surgery without any mortality.
excision of abscess by craniotomy in 16 (9.87%) cases
and third ventriculoscopic (endoscopic) tubercular DISCUSSION
abscess drained with endoscopic third ventriculostomy)
in third ventricular floor tubercular abscess in Brain abscess is an intraparenchymal collection
one (0.62%) cases [Figure 6]. Types of operations, of pus. The incidence of brain abscesses is about
residual neuro-deficit, mortality and outcome are 8% of intracranial masses in developing countries,
illustrated in Table 4. Pus culture indicated negative whereas, in Western countries, the incidence is about
results in 145 (89.5%) cases. Anaerobic culture and 1-2%. [1,4-6] Though potentially curable, there was still
culture for Mycobacterium failed to yield any bacterial a diagnostic and therapeutic challenge. In the last two
growth. Organisms isolated from pus culture are shown decades, there is a major advance in the diagnosis and
in Table 6. management of brain abscesses, with a corresponding
improvement in the survival rate. In the development
Total number of death was 22 (13.58%) cases. Complete of brain abscess, inoculation of an organism is required
resolution of an abscess with complete recovery of into the brain parenchyma in an area of devitalized
brain tissue or in a region with poor microcirculation,
Table 5: Gender distribution, number of abscess and and the lesion evolves from an early cerebritis stage
laboratory findings of patients to the stage of organization and capsule formation.
[7]
Demographic variables Number (%) Histologically, there are four stages in brain abscess
Gender formation: early cerebritis (day 1-3), late cerebritis (day
Male 125 (77.16)
Female 37 (22.84) 4-9), early encapsulation (day 10-13) and late capsule
Raised lab parameters stage (day 14 onward). About 2 weeks are required
ESR 41 (25.35) for encapsulation, which is usually less complete
CRP 84 (51.85)
WBC 78 (48.14) on medial or ventricular side due to poor vascular
Number of abscess supply. [8,9] The mode of entry of organisms could be by
Single 126 (77.7) contiguous spread, hematogenous dissemination, or
Multiple 36 (22.3) [4]
ESR: erythrocyte sedimentation rate; CRP: C‑reactive protein; WBC: white blood cell following trauma. The common predisposing factors
of a brain abscess are CSOM, congenital cyanotic heart
disease, and paranasal sinusitis. [1,5,10-12]
Table 6: Culture‑positive bacterial‑fungal isolates from
brain abscesses
Bacteria‑fungus Number of patients Percentage Immunosuppression due to disease or therapy is
Streptococcus intermedius 2 10.5% emerging as an important risk factor for the development
[4]
Ps. Aeruginosa 3 of brain abscess. Here, we found predisposing factors
Staphylococcus areus 4 of brain abscesses were similar.
Streptococus epidermidis 1
Streptococcus pyogenes 3
Streptococcus pneumoniae 1 The most common organism isolated from a brain abscess
Mycobacterium 0 was Staphylococcus aureus in the preantibiotic era.
[5]
Anarobic 0 Now, Streptococcus spp. have replaced Staphylococcus
Fungal 3 [5,13]
No growth 145 89.5% spp. as the most common organisms. Based on the site
Ps. eruginosa: Pseudomonas aeruginosa of origin, the organisms would be different. Streptococci

156 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 157