Brain abscess

Prognosis and complications
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By John E Greenlee MD

Brouwer and colleagues recently performed a meta-analysis of 123 studies including 9,699 patients reported between 1935 and 2012, and they recorded a 20% mortality rate in brain abscess (Brouwer et al 2014b). Survival in brain abscess approaches 100% in patients who are fully alert at presentation and remains over 90% in patients who are stuporous but not comatose when first seen (Nielsen et al 1982; Fritz and Nelson 1997; Helweg-Larsen et al 2012). However, only 41% of patients responsive to pain will survive, and survival has remained unchanged over the past 3 decades (11 to 18%; 82 to 89% mortality) in patients who are without pain response (Nielsen et al 1982; Helweg-Larsen et al 2012). Adverse prognostic factors include delay in diagnosis; choice of inappropriate antibiotics; inadequate aspiration or drainage; multiple, large, deep, or multiloculated abscesses; posterior fossa abscesses; and intraventricular rupture (Chun et al 1986; Kastenbauer et al 2004; Corre et al 2011; Helweg-Larsen et al 2012; Brouwer et al 2014a; Brouwer et al 2014b). Severity of residual neurologic defects is heavily influenced by neurologic status at the time of admission and may also be better in cases successfully treated with antibiotics alone or with antibiotics plus aspiration (Fritz and Nelson 1997). Both morbidity and mortality are higher with Gram-negative than with Gram-positive infections (Prasad et al 2006; Tseng and Tseng 2006). Neurologic deficits will be found in 30% to 55% of patients surviving brain abscess and are incapacitating in 17% (Kastenbauer et al 2004): these may be secondary to the abscess itself or to complications of surgical intervention. Incidence of seizures in different series has ranged from 11% to 35% of patients and usually occurs within 12 months after surgery (Koszewski 1991; Roche et al 2003; Kastenbauer et al 2004). The likelihood of subsequent seizures may be reduced by early therapy with anticonvulsant medication.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors