Management of cerebral abscess in adolescents and adults

Thirty-seven patients with non-traumatic intracerebral abscesses are presented. Two were not diagnosed during life. Where the possible cause could not ascertained, a metastatic origin was the commonest, followed by otogenic. A variety of causative organisms, including especially Streptococci, Staphylococci and Bacteroides were isolated. It is possible that the most effective treatment was primary excision of the abscess plus antibiotics, but the numbers were too small for a statistically significant difference to be shown. The reasons for recent improvements in outcome of brain abscesses, including more use of CT scanning and refinements in isolation of organisms and in antibiotic treatment, are discussed, along with possible steps towards more improvement in future.