Diagnostic and staged stereotactic aspiration of multiple bihemispheric pyogenic brain abscesses

Abstract

Empiric antibiotic therapy for multiple brain abscesses is not advised, as biopsy to rule out other causes and material for cultures can be obtained with minimal morbidity using computed tomography (CT)-guided stereotaxy. We report a good outcome following treatment of this 60-year-old nonimmunocompromised patient with six pyogenic cerebral abscesses. CT-guided stereotactic aspiration of two abscesses were done on the first occasion and appropriate antibiotics were administered. Serial CT scans were done and the abscesses that recollected or enlarged were again aspirated. Group A beta hemolytic streptococci were grown from the pus. Two abscesses recollected and one enlarged during antibiotic therapy. These were aspirated on the second and third occasions, 1 week and 2 weeks after the first procedure. The abscess less than 3 cm resolved with antibiotics alone. Intravenous crystalline penicillin, chloroamphenicol, and metronidazole were given for 2 weeks followed by oral ampicillin and cotrimoxazole for 10 weeks. There was no morbidity related to the multiple procedures and the patient had a good outcome at the end of 16 weeks. CT-guided stereotactic aspiration of multiple brain abscesses is known to have a low morbidity and mortality. We highlight the additional option of multiple, staged aspirations for those abscesses not readily responding to antibiotic therapy.