Brain Abscess Follow-up

Updated: Mar 02, 2021
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Follow-up

Further Inpatient Care

Most abscesses are managed with intravenous antibiotic therapy to enable the organization of the lesion and to reduce local extension of the infection. After that period, definitive treatment consists of aspiration, incision and drainage, or excision.

Currently, nonoperative approaches (ie, prolonged courses of parenteral antibiotics) are rarely used. An exception is an abscess at an inoperable site. Such cases are uncommon, as many abscesses that were once inoperable can now be reached by stereotactic aspiration guided by precision mapping of the lesion's location with CT or MRI. Magnetic resonance fluoroscopy is used to guide aspiration instead of stereotactic aspiration.

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Complications

Permanent neurological damage may include hemiparesis, cranial nerve palsy, hydrocephalus, intellectual and behavioral disorders, ataxia, spasticity, visual defects, and optic atrophy. Recurrent seizures develop in about 10-30% of survivors.

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Prognosis

Mortality has declined since the introduction of CT and MRI and the development of newer surgical techniques. Mortality rate is about 15%. The mortality is higher in immunocompromised, those who had a transplant, and those with brain stem or deep hemispheric abscesses.

A poorer prognosis is associated with a delayed diagnosis or a misdiagnosis, severe mental status changes at the time of diagnosis, rapid progression of the infection and neurological impairment, multiple and deep abscesses, ventricular rupture, the presence of coma or stupor at diagnosis, inadequate treatment, and specific organisms (ie, Aspergillus species, other fungi, Pseudomonas species).

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Infections Center and Brain and Nervous System Center. Also, see eMedicineHealth's patient education articles Brain Infection and Antibiotics.

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