Persisting Incidence and Mortality of Sinogenic Cerebral Abscess: A Continuing Reflection of Late Clinical Diagnosis

Abstract

Seventy-four verified cases of cerebral abscess seen in the Regional Neurosurgical Centre at Addenbrookes Hospital, Cambridge between 1965 and 1987 were reviewed. During that time no decline in incidence or change in the associated mortality was found to occur. ENT disease, taken as a whole, represented the most common source (40%) while acute frontal sinusitis (23%) proved to be the most common single underlying cause. Cerebral abscesses of sinogenic origin in particular were diagnosed late, with a deteriorating conscious level being the precipitating event in 94% of cases. Over 80% of such patients had presented initially to a non-ENT department with acute frontal headache where neither the underlying frontal sinusitis nor the developing intracranial complication had been suspected. These findings might explain why the incidence and mortality associated with cerebral abscesses of sinogenic origin, have changed little in the last 25 years despite improvements in diagnostic imaging, surgical technique and antibiotic therapy. We recommend that the diagnosis of acute frontal sinusitis be considered in any patient who presents with acute frontal headache, particularly if symptoms are unilateral. Furthermore, we stress that early confirmation of intracerebral complications by computerized axial tomography (CT) scanning continues to depend entirely upon an early clinical diagnosis which should result from a high level of clinical suspicion in patients who develop intracranial symptoms in the presence of known acute frontal sinus infection.