Schielke E
Neurologische Universittsklinik der Charité, Humboldt-Universität zu Berlin.
Nervenarzt. 1995 Oct;66(10):745-53.
The most common symptom of brain abscesses are headache, nausea, fever, disturbance of consciousness, focal signs and seizures. CT is the most useful investigation, showing ring-enhancing lesions with perifocal edema. Systemic inflammatory signs, cerebrospinal fluid changes and cerebral enhancement on leukocyte scintigraphy are of limited diagnostic value. In 10-20% of cases, diagnosis can only be established by biopsy. The most frequent organisms are aerobic streptococci, anaerobes, gram-negative bacilli and staphylococci. Metronidazole in combination with a third-generation cephalosporin and--in certain cases--an antistaphylococcal antibiotic should be given for at least 4 weeks. Conservative treatment can give satisfactory results in abscesses less than 2-3 cm in diameter. Medium-sized and deep-seated abscesses are treated by CT-guided stereotactic aspiration. In very large abscesses with the risk of herniation craniotomy and excision are necessary. Mortality is nowadays 5-15% and does not depend on treatment modalities. Prognosis is mainly determined by the patient's level of consciousness on admission.
脑脓肿最常见的症状是头痛、恶心、发热、意识障碍、局灶性体征和癫痫发作。CT是最有用的检查手段，显示有环状强化病灶及灶周水肿。全身炎症体征、脑脊液变化以及白细胞闪烁扫描的脑部强化，诊断价值有限。在10% - 20%的病例中，只能通过活检来确诊。最常见的病原体是需氧链球菌、厌氧菌、革兰氏阴性杆菌和葡萄球菌。应给予甲硝唑联合第三代头孢菌素，某些情况下加用抗葡萄球菌抗生素，疗程至少4周。直径小于2 - 3厘米的脓肿采用保守治疗可取得满意效果。中等大小和深部脓肿通过CT引导下立体定向抽吸治疗。对于有脑疝风险的非常大的脓肿，需要进行开颅手术和切除。目前死亡率为5% - 15%，且与治疗方式无关。预后主要取决于患者入院时的意识水平。
