Nonsurgical Management of Brain Abscess

Until the early 1970s, surgery was considered essential in the management of brain abscess. However, in 1971, it was suggested that brain abscess might be successfully treated non-oper-atively, using antibiotics alone. In 1986, a review was published of 67 cases of encapsulated brain abscess managed non-operatively [15]. The success rate of non-surgical therapy was 74% and the mortality 4%, although many of these lesions may have been treated during the cerebritis stage, which may have facilitated resolution. Antibiotics were chosen based on culture of organisms isolated from blood, CSF or other fluids in 49% of cases and by aspiration of one of multiple abscesses in 23% of patients, leaving 28% treated without a definitive diagnosis. This last figure is significant because a variety of intracranial processes (primary or metastatic tumors, resolving hematoma, infarc tion, etc.) can mimic both the clinical presentation and radiographic appearance of an abscess. Consequently, it is not inconceivable that a non-infectious process might be erroneously treated with antibiotics. It is especially critical to obtain cultures in immunocompromised patients who may harbor opportunistic infections not responsive to conventional antimicrobial therapy. Additionally, removal of purulent material provides a more favorable environment in which antibiotics can work and provides immediate reduction in mass effect and ICP. Therefore, with stereotactic techniques so readily available, it should be the rare case in which treatment is undertaken without obtaining a biopsy or culture material.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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