Outcome
The outcome for patients with brain abscess has improved over the years. Overall mortality is <13%, with permanent hemiparesis and long-term seizures both under 50%.[55]Hall WA. Cerebral infectious processes. In: Loftus CM (ed): Neurosurgical emergencies. Park Ridge, IL: American Association of Neurological Surgeons Publications; 1994:164-82. The major prognostic factor is the patient's neurological status upon presentation. Early diagnosis and prompt treatment correlates with improved outcome.[56]Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. 2007 Jan;26(1):1-11.
http://www.ncbi.nlm.nih.gov/pubmed/17180609?tool=bestpractice.com
[57]Kao PT, Tseng HK, Liu CP, et al. Brain abscess: clinical analysis of 53 cases. J Microbiol Immunol Infect. 2003 Jun;36(2):129-36.
http://www.ncbi.nlm.nih.gov/pubmed/12886965?tool=bestpractice.com
Other factors associated with poor outcome include intraventricular rupture, use of chronic corticosteroids, the presence of cyanotic heart disease, an immunocompromised state, and the identification of Nocardia asteroides or Naegleria fowleri as the aetiological agent.[58]Mampalam TJ, Rosenblum ML. Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery. 1988 Oct;23(4):451-8.
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[59]Song L, Guo F, Zhang W, et al. Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci. 2008 Dec;29(6):425-30.
http://www.ncbi.nlm.nih.gov/pubmed/19002652?tool=bestpractice.com
[60]Takeshita M, Kagawa M, Izawa M, et al. Current treatment strategies and factors influencing outcome in patients with bacterial brain abscess. Acta Neurochir (Wien). 1998;140(12):1263-70.
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[61]Zakaria A, Elwatidy S, Elgamal E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien). 2008 Oct;150(10):1097-101.
http://www.ncbi.nlm.nih.gov/pubmed/18773137?tool=bestpractice.com
A high risk of reduced cognitive performance has been shown in children with cyanotic heart disease and in neonates with brain abscess.[1]Renier D, Flandin C, Hirsch E, et al. Brain abscesses in neonates: a study of 30 cases. J Neurosurg. 1988 Dec;69(6):877-82.
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