Brain abscess

Historical note and nomenclature
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By John E Greenlee MD

The notion that ear infections could progress to delirium and death, a series of clinical events consistent with brain abscess as well as subdural empyema or septic venous thrombophlebitis, was known to ancient writers, including Hippocrates (Kastenbauer et al 2004). Morand, in the 16th century, is the first individual credited with successful drainage of a brain abscess. Methodical development of surgical approaches to brain abscess, however, did not begin until the latter part of the 19th century (Canale 1996). Beginning at this same time, development of effective surgical treatment of chronic otitis, a major cause of purulent intracranial infections, caused a fall in the incidence of otogenic brain abscess long before the advent of antibiotics.

Prior to CT, diagnosis of brain abscess remained elusive, with treatment ultimately surgical; antibiotics were assigned an adjunctive, but not usually curative, role. Since the late 1970s, however, the introduction of CT and subsequently MRI has provided for the first time rapid, noninvasive methods for diagnosing and monitoring brain abscess (Enzmann et al 1983; Enzmann 1993; Hatta et al 1994). With the widespread use of these neuroimaging techniques, mortality from brain abscess has fallen, and it has become possible to treat a portion of brain abscesses with antibiotic therapy alone (Obana and Rosenblum 1992; Hsiao et al 2011), or to drain abscesses using stereotactic, CT-, or MR-guided needle aspiration (Mamelak et al 1995; Chacko and Chandy 1997; Barlas et al 1999; Nakajima et al 1999; Kollias and Bernays 2001; Helweg-Larsen et al 2012).

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited