Brain abscess: recent experience at a community hospital.

Brain abscess is a formidable diagnostic and therapeutic problem with mortality ranging from 35% to 65%. It may occur at any age, and there is a male:female ratio of 2:1. Brain abscess arises from a contiguous focus of infection, direct implantation due to trauma, or hematogenous spread from a remote site. The commonest organisms isolated from brain abscess include streptococci, Staphylococcus aureus, Bacteroides species, and Enterobacteriaceae. Brain abscess frequently produces headache, vomiting, focal neurologic signs, and depressed level of consciousness. Fever and leukocytosis often are absent. Diagnosis is suggested by computerized tomography, but most cases require surgical confirmation. Optimal management consists of intensive antibiotic therapy. Aggressive surgical treatment is required in cases not responding to antimicrobial therapy. Long-term neurologic deficit occurs in up to 60% of cases.