Sharma B S, Khosla V K, Kak V K, Gupta V K, Tewari M K, Mathuriya S N, Pathak A
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Acta Neurochir (Wien). 1995;133(1-2):36-43. doi: 10.1007/BF01404945.
Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered "sensorium" at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome. Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.
38例多发性化脓性脑脓肿患者占12年期间所有接受治疗的脑脓肿患者的11%。60%（23例）的患者年龄在20岁以下，其中包括9例（24%）婴儿。临床表现与一般脑脓肿相似。21例患者入院时存在意识改变。耳源性脑脓肿最为常见（26%），其次是与先天性青紫型心脏病相关的脑脓肿（18%）。脓肿总是很大。11例（29%）患者的脓液培养无菌，而9例（24%）患者培养出的最常见病原体是金黄色葡萄球菌。29例（76%）患者需要进行脓液抽吸作为挽救生命的措施，以控制颅内压升高。其中12例（32%）患者接受了脓肿包膜的二期切除。总体死亡率为32%，未能控制颅内和全身感染是主要死亡原因。入院时的意识水平是影响预后的最重要因素。手术在多发性化脓性脑脓肿的治疗中具有明确的治疗和挽救生命的作用。本文提出了针对多发性脓肿的系统治疗方案。
