The medical records of fifty-seven patients with intracranial abscess which had been admitted to the departments of neurology, neurosurgery, otolaryngology and pediatrics, in Seoul National University Hospital from 1983 to1992 were reviewed. Mean
age
was 31.4 years, ranging from 3 to 66 years. Male predominated with the ratio of 2.6:1.
Common predisposing conditions were headrt disease, parameningeal infection such as chronic otitis media, paranasal sinusitis, pulmonary infections in order of frequency. Primary focus was not determined in 16% of cases. A wide range of organisms
were
encountered and aerobes were more frequently cultivated than anaerobes. In 56% of cases, pathogens were not confirmed. The use of preoperative antibiotics was not significantly correlated with sterile cultures.
Initial symptoms and signs were usually nonspecific; headache in 89%, fever in 53%, nausea and vomiting in 54%, altered consciousness in 39%.
Computed tomography was the most accurate and rapid diagnostic tool, and serial follow-up during the treatment was helpful in knowing whether the response to several treatment modalities was good or not.
Of the fifty-seven cases, twenty-seven patients were operated; 17 patients underwent aspiration of the abscessed, and ten patients received resection of abscesses. Sixty three percents of surviving patients suffered from neurologic sequelae; most
commonly epilepsy in 50%. The mortality rate among all treated patients was significantly related to the initial consciousness level and the number of the abscesses, but not to the size of lesion, identification of organism, age or sex.
Although non-surgical therapy is appropriate in some selected patients, surgical intervention should be considered, when the considered, when the consciousness level deteriorates or the CT findings are aggravated after full dose of combination
antibiotics.
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