Complex Treatment of Primary Abscess of the Brain

Podgornyak M.Yu.

(Neurosurgical Department of the Mariinsky Hospital)

Male patient M., born in 1946, was admitted on February 15, 2001. He was sick since the middle of January, when there appeared headache, localized mainly in the frontal area. Besides, there was edema of eyelids. The maxillary sinus was punctured by an otolaryngologist (there was no discharge). Outpatient treatment had no effect. The patient's state aggravated on February 11, 2001. There appeared augmentation of weakness and headache, subfebrile temperature and loss of appetite. The patient was delivered to Hospital N 30 on February 11, 2001 with influenza. However, CT examination showed the mass in the right frontal lobe of the brain (abscess). On admission the patient was in a severe general state; there were marked torpor, limited movements of eyeballs to the sides and upwards, the smoothed down nasolabial fold, mild hemiparesis and Babinsky's syndrome on the left, moderate rigidity of occipital muscles. Emergency operation was performed on February 16,2001. It included osteoplastic trephination in the left frontotemporal area, removal of abscess of the frontal lobe with tidal drainage of its cavity, supplemented by antibiotics and used during three days, and subsequent passive drainage during one day. There were no complications in a postoperative period. The wound healed by first intention. Control CT examination demonstrated a state after abscess removal and a moderate edematous zone.

The culture of abscess contents showed growth of Stahylococcus Aureus (gentamicin+++, oxacillin+++, cephazolin+++, ciprofloxacine+++, erythromycin+++). Claforan, gentamicin and ciprofloxacine were used for antibiotic therapy in a postoperative period.

The latter was characterized by improvement of the patient's state, regress of focal and common cerebral symptoms. The patient was discharged for further outpatient treatment and follow up by a neurologist of a polyclinic. His state on discharge was satisfactory.

The demonstration goal:

To show efficacy of treatment of the brain primary abscess by means of a complex approach, consisting in timely intervention, drainage of a cavity of removed abscess in a postoperative period and combined antibacterial therapy.