Intracranial abscesses

ABSTRACT

Twenty patients with the proven diagnosis of intracranial abscess were studied following admission to Jordan University Hospital. Seventy percent of the affected were children below 15 years of age. Fifty five percent had symptoms for more than ten days prior to admission. All patients had vomiting. Sixty per cent had papilloedema and 35% were unconscious on hospitalisation. All patients had computed tomograms [CT]. Eight patients were treated by repeated aspiration and eight by craniotomy and excision, the remaining four by external drainage. The commonest types were metastatic abscesses [45%] and otogenic abscesses [30%]. Twenty percent of cultured specimens were sterile, and the commonest isolated organism was staphylococcus aureus coagulase positive [20%]. The mortality of the series was 30%.The mortality following pyogenic intracranial abscesses remains high and had ranged from 10% to 50% in recently reported series. The development of recent diagnostic tools and the improvement of the general health of the population did not lead to any significant decline in the incidence and /or mortality of the disease. Garfield[6] and Morgan, Wood and Murphy[5], found that the incidence did not vary over two decades. Seller, Sahar and Praiss[1] and Samson and Clark[7] suggested that the incidence is increasing. The causative organisms as well as the source of infection vary in different reports. Pennybaker[8] reported that 40% of brain abscesses were of otogenic origin, while Fischer et al[4] reported 25% in their series of 94 patients. And while many workers report that staphlococcus aureus is the commonest encountered organism, others tend to incriminate proteus, bacteroids and anaerobic streptococcus. The choice of surgical approach remains controversial, so while all workers agree about the role of antibiotics and steroids, they differ between repeated aspirations or craniotomy and excision. The purpose of this study is to share our experience with other workers and to find if the patterns of intracranial abscesses in Jordan varied from those of other countries