Multiple brain abscess: a review of fourteen cases.

The case notes of 14 consecutive patients with multiple brain abscesses presenting over a 14 year period were studied with respect to the incidence and presentation, the source of infection, the investigations, microbiology and the treatment and outcome. The incidence of multiple brain abscesses in non-immunocompromised patients is 13% of all intracranial abscesses. Computerized tomographic scanning is vital both in the detection of multiple abscesses and in the subsequent assessment of therapy. The source of infection in half of our patients was the teeth or the paranasal sinuses. Streptococci were isolated in 63% of the patients; staphylococci in 21%. This has obvious implications for the antibiotic policy. Intracranial surgery, with few exceptions, had a diagnostic and management role rather than a curative one; identification of the causative organism was its prime purpose. CSF, obtained by lumbar punctures, did not provide any positive cultures and should not be contemplated in view of the inherent hazards. The elimination of the primary focus of infection was a most important step in the management of this condition. Multiple brain abscesses represent a potentially curable condition, provided appropriate antibiotics are used, the primary septic focus is eliminated and the intracranial complications are anticipated by the use of frequently repeated CT scans.