Brain abscess: a review

Abstract

Objective: To carry out a current review of brain abscess data source: review of all the published literature on the brain abscess until august 2016 was carried out through internet, google, pubmed and medline searches.

Data selection: Published data on brain abscess were included in the review.

Data extraction: Abstracts of relevant articles identified were assessed, read and analyzed to determine their relevance to the brain abscess, the subject under review.

Data synthesis: After establishing relevance from the abstract, the entire paper was read and the significant points included in the subject under review.

Conclusion: Brain abscesses are rare with significant consequences of missed or delayed diagnosis, but remain one of the most common neurological emergencies especially in developing countries, being 8% of intra-cranial space occupying lesions compared to 1%-2% in the developed countries. In the pre-antibiotics, CT, and MRI eras, brain abscess was almost always 100% fatal. The reduction in morbidity and mortality over the past five decades is attributed to recent advances and increased availability of computer tomography with double contrast enhancement which provides early and reliable diagnosis, localisation, and characterisation of abscesses and monitoring the effectiveness of treatment. Magnetic resonance imaging (MRI) with gadolinium enhancement has much greater sensitivity and specificity than CT making it the procedure of choice, while MRI together with diffusion weighted imaging with a sensitivity and specificity of 90% distinguishes brain abscesses from necrotic brain tumours. Advances in microbiological isolation techniques, efficient combination anti-microbial, anti-tuberculus and anti-fungal therapy, stereotactic aspiration and technology assisted neurosurgical techniques have resulted in significant reduction in morbidity and mortality globally.