Romanian Neurosurgery (Jan 2023)
Brain abscess – a still high mortality medical condition
Abstract
Background. Even in the 21st century, infections of the central nervous system and their secondary damage still represents a high mortality condition. Furthermore, brain abscesses (BA) are huge public health issues due to their high mortality and morbidity with high financial implications for the health care system. Material and methods. In this article, we want to present our clinic`s experience in the management of brain abscesses between 2012 and 2021. A 10 years retrospective study was performed in the 4th Neurosurgery Department of “Bagdasar-Arseni” Clinical Emergency Hospital in Bucharest Results. In the last 10 years, our clinic admitted 46 patients, 10 women and 36 men. The mean age was 47 years old. The most common symptom was headache (42 cases). In 39 cases, patients had solitary abscesses while seven patients presented multiple abscesses. The therapeutic approach was classic surgery in 37 cases. In four cases abscess drainage was performed and in five cases conservative treatment was used. At discharge, 31 patients were healed and seven patients died. Discussions. In BA management, antimicrobial therapy is crucial. Thus, identifying the pathogen is crucial for accurate antimicrobial treatment. Unfortunately, in too many cases, the agent remains unknown and empiric treatment is required. Aspiration of the abscesses proved to be safe and with similar results compared to classic surgery. Conclusions. Brain abscesses remain a high challenge to manage even in the 21st century. Broad-spectrum antibiotic treatment should be applied as soon as possible until the pathogen is identified and specific treatment will be used.
