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Kafle et al. Neuroimmunol Neuroinflammation 2018;5:24 Neuroimmunology
DOI: 10.20517/2347-8659.2018.10 and Neuroinflammation

Original Article Open Access

Shifting paradigm in brain abscess management at
tertiary care centre in Nepal

Prakash Kafle , Mohan Raj Sharma , Sushil Krishna Shilpakar , Gopal Sedain , Amit Pradhanang ,
2
2
2
2
1
Ram Kumar Shrestha , Binod Raj Bhandari , Christine Groves 3
2
2
1 Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar 56613, Nepal.
2 Department of Neurosurgery, Tribhuvan University Teaching Hospital, Kathmandu 44613, Nepal.
3 Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Correspondence to: Dr. Prakash Kafle, Department of Neurosurgery, Nobel Medical College Teaching Hospital, Biratnagar
56613, Nepal. E-mail: prakashkaflee@gmail.com
How to cite this article: Kafle P, Sharma MR, Shilpakar SK, Sedain G, Pradhanang A, Shrestha RK, Bhandari BR, Groves C. Shifting
paradigm in brain abscess management at tertiary care centre in Nepal. Neuroimmunol Neuroinflammation 2018;5:24.
https://doi.org/10.20517/2347-8659.2018.10
Received: 21 Mar 2018 First Decision: 28 Apr 2018 Revised: 16 May 2018 Accepted: 17 May 2018 Published: 7 Jun 2018
Science Editor: Athanassios P. Kyritsis Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Aim: Brain abscess is a challenging clinical entity with substantial high case fatality rates despite significant advances
in imaging techniques, laboratory modalities, surgical interventions, and antimicrobial treatment.Otogenic and
cardiogenic sources are among the most common. Classic clinical presentation is seen in very few cases only. Burr hole
with aspiration works well with good clinical outcomes. Control of primary source in cases of ear infection in the single
setting results in good outcomes, reduces for additional surgery, and decreases the duration of hospital stay.

Methods: This is prospective observational study conducted at Institute of Medicine, Tribhuvan University Teaching
Hospital, Kathmandu, Nepal over the period of two and a half years (from September 2014 to March 2017).We analyzed
the demographic profile, management strategies and outcome of these cases diagnosed with brain abscess using
Microsoft Excel 2007.

Results: A total of 51 cases were undertaken for surgical management. There were 35 males and 16 females with the
male to female ratio of 2.18:1. The mean age of the study population was 16.76 years with age range from 4 months to
60 years. Otogenic source was the most common. Temporal lobe was the most common abscess location. Headache
was the most common clinical presentation and was seen in 86.27% of the study population. All cases were initially
managed with burrhole and aspiration of the abscess. Only 3.92% (n = 2) of cases subsequently required surgical
excision of the abscess wall. Only 11.76 % (n = 6) of the cases required multiple aspiration. Only 19.61% (n = 10) showed
positive culture. Pseudomonas aeruginosa and E. coli were the most common organisms grown. Mortality rate among
the study group was 3.92%.

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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