Diagnosis and treatment of brain abscesses

Abstract

The etiologic pathogens of brain abscesses vary depending on the underlying disease. Aerobic and anaerobic bacteria are frequently involved simultaneously. In most cases, the clinical course is subacute. C-reactive protein is the most sensitive inflammatory parameter in the blood. It is elevated in 80 to 90% of all cases. The diagnosis is made by cranial computer tomography without and with contrast enhancement. The rapid culture of pus from the abscess cavity is crucial for the identification of the pathogen. Antibiotic therapy alone is indicated 1. in the presence of multiple, small and/or deep-seated abscesses or 2. when the general condition of the patient does not allow surgery at an acceptable risk or 3. in early cerebritis without capsule formation. Frequently used surgical procedures are abscess aspiration (usually by stereotaxic surgery), open craniotomy and excision of the abscess with the capsule, and open evacuation of the abscess cavity. For empirical treatment the combination of cefotaxime (3 x 2-4 g/d i.v.) plus metronidazol (3-4 x 0.5 g/d i.v.) is preferred. Corticosteroids are indicated in the presence of a space-occupying effect and imminent brain herniation, or of multiple abscesses and abscesses in critical brain regions such as in the cerebellum.