REVIEW

CURRENT
OPINION Epidemiology, diagnosis, and treatment of
brain abscesses
Matthijs C. Brouwer and Diederik van de Beek

Purpose of review
This article describes the epidemiology, diagnosis, and treatment of brain abscesses focusing on studies
published in the past 2 years.
Recent findings
In the recent literature, advances have been made in describing the disease, ancillary investigations, and
treatment, mostly by combining previously available literature in meta-analyses. These studies identified
Staphylococcus and Streptococcus species as the most frequent cause of brain abscess. New developments
include the analysis of genetic risk factors for brain abscess, evaluation of shorter antibiotic courses, and
the use of hyperbaric oxygen treatment. However, many studies in this field are limited by methodology
and results are less helpful for clinical practice. Nevertheless, there has been a gradual improvement in the
outcome of patients with brain abscess over the past 50 years, which might be driven by improved brain
imaging techniques, minimally invasive neurosurgical procedures, and protocoled antibiotic treatment.
Multicenter prospective studies and randomized clinical trials are needed to further advance treatment and
prognosis in brain abscess patients.
Summary
Our understanding of brain abscesses has increased by meta-analysis on clinical characteristics,
ancillary investigations, and treatment modalities. Prognosis has improved over time, likely due to
improved brain imaging techniques, minimally invasive neurosurgical procedures, and protocoled
antibiotic treatment.
Keywords
antibiotic treatment, brain abscess, magnetic resonance imaging, neurosurgery

INTRODUCTION
Brain abscesses are focal infections of the brain that
can present with a wide variety of symptoms and
signs, depending on the number, location, and size
&& &&
of the abscess [1 ,2 ]. Brain abscess can be caused
by diverse micro-organisms including bacteria,
mycobacteria, protozoa, helminths, and fungi.
The incidence has previously been estimated at
0.3 and 0.9 per 100 000 population, but accurate
figures are not available for large parts of the world
[3,4]. In immunocompromised patients due to HIV,
use of immunosuppressant or organ transplan-
tation, the incidence is thought to be substantially
higher [4,5]. In these patients, the causative organ-
isms are more likely to be opportunistic, and empiric
treatment and ancillary investigations should take
this into account.
In this review, we describe the recent publi-
cations on epidemiology, diagnosis, and treatment
of brain abscess.
EPIDEMIOLOGY
Few studies [3,4] on the incidence of brain abscess
representing population-based estimates have been
published. A study [3] from Minnesota, USA showed
a declining incidence from 2.7 to 0.9 per 100 000
population between 1935 and 1981. A study [6] from
Copenhagen, Denmark, performed between 1994
and 2009, showed an incidence of 0.4 per
100 000. More recently an overview study [7] from
Finland, describing patients from a tertiary referral
Department of Neurology, Centre of Infection and Immunity Amsterdam
(CINIMA), Academic Medical Centre, Amsterdam, the Netherlands
Correspondence to Dr Matthijs C. Brouwer, MD, PhD, Department of
Neurology, Centre of Infection and Immunity Amsterdam (CINIMA),
Academic Medical Centre, University of Amsterdam, PO Box 22660,
1100DD Amsterdam, the Netherlands. Tel: +31 20 566 4042;
fax: +31 20 566 9374; e-mail: m.c.brouwer@amc.uva.nl
Curr Opin Infect Dis 2017, 30:129–134
DOI:10.1097/QCO.0000000000000334

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CNS infections
KEY POINTS
 Staphylococcus and Streptococcus species are the most
frequent causes of brain abscess.
 Brain MRI with DWI is the most sensitive imaging test
for brain abscess.
 Early aspiration of brain abscesses is vital to acquire
the pathogen and rationalize treatment.
 Stereotactic aspiration of brain abscess has emerged as
a minimally invasive procedure with low associated
complication rate.
 The prognosis of patients with brain abscess has
gradually improved over the past 50 years.
center admitted between 1970 and 2012, reported
an incidence of 0.3 per 100 000. A 70% majority of
brain abscess patients are male, and the average age
is 34 years, although it can occur in patients of any
&&
age, including neonates [2 ].
A meta-analyses of cohort studies published in
2014 summarized data from 9699 patients included
in 123 studies of which 90% were single-center and
&&
94% were retrospective [2 ]. Most studies focus on
bacterial brain abscesses, and therefore the reported
proportion of nonbacterial brain abscesses is an
underestimation. The meta-analysis showed that
the pathogen could be identified in 68% of brain
abscess cases, and in 23% of positive cultures
multiple bacteria were identified. The majority of
culture positive cases was due to streptococcal (34%)
&&
and staphylococcal species (18%) [2 ]. Distribution
of bacterial pathogens identified in brain abscesses
was relatively similar over continents, and has been
&&
stable over the past 60 years [2 ].
RISK FACTORS
The majority of patients with brain abscesses have
predisposing conditions, which may provide clues
&&
toward the causative micro-organism [1 ,4]. Con-
tiguous spread of bacteria occurs in half of the cases
and can result from penetrating trauma, neurosur-
gery, or infections of the ear and paranasal sinuses
&& &&
[1 ,2 ]. The pathogens associated with contiguous
spread are Staphylococcus aureus, anaerobic and aer-
obic Streptococcus species, but also enterobacteria,
Klebsiella, Proteus, and Salmonella species have been
&&
described [1 ]. Hematogeneous spread of bacteria
can occur in patients with endocarditis, congenital
heart disease, lung infections, or dental infections
&&
and is identified in one-third of patients [2 ]. Brain
abscesses associated with endocarditis are typically
caused by S. aureus and Streptococcus spp., whereas
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underlying dental and sinus infections are associ-
ated with polymicrobial infections, which often
include Fusobacterium, Prevotella, Actinomyces, Bac-
teroides, and Haemophilus species.
The most important cause of brain abscess in
HIV-infected patients is Toxoplasma gondii, which
typically present with multiple small abscesses.
Other HIV-related brain abscess causes are Nocardia
species and Mycobacterium tuberculosis [1 ]. Patients
&&
with solid-organ or hematopoietic stem-cell trans-
plantation, or neutropenia following chemotherapy
are at risk for fungal abscesses due to Aspergillus,
Candida, Mucorales, and Scedosporium species. Bac-
terial causes in this group include Enterobacteriaceae
such as Escherichia coli, Enterobacter, Klebsiella,
&&
Proteus, and Salmonella species [1 ].
Genetic variation has recently been associated
&
with the risk of brain abscess [8 ]. A genetic associ-
ation study suggested that single nucleotide poly-
morphisms in the ICAM-1 and MCP-1 genes increase
&
susceptibility [8 ]. The study in 100 patients and 100
controls showed that these genetic variants were
associated with levels of ICAM-1 and MCP-1 in
abscess and blood samples. However, selection of
controls was not specified and the number of partici-
pants is low for a genetic association study. Vali-
dation of these results in larger cohorts is therefore
warranted.
DIAGNOSIS
The clinical presentation of patients with brain
abscess can be highly diverse. The classic triad of
brain abscess includes headache, fever, and focal
neurologic deficits, which are found in 69, 53,
and 48% of patients, respectively [2 ]. All three
&&
symptoms together are identified in only 20% of
&&
patients [2 ]. Patients may however also present
with only progressive changes in behavior or cog-
nitive defects, without focal neurologic deficits or
fever (Fig. 1). Therefore, the identification of a brain
abscess on cranial imaging may sometimes be an
unexpected event because of the low initial clinical
suspicion. Cranial imaging is crucial in the diagnosis
of brain abscesses and should be performed in all
&&
patients in whom it is suspected [1 ,9]. Computed
tomography (CT) with intravenous contrast
enhancement can be used for determining the size
and number of abscesses but cannot accurately dis-
criminate between metastases or primary brain
tumors and brain abscesses. Magnetic resonance
imaging (MRI) however, is a valuable diagnostic tool
in differentiating brain abscess from primary, cystic,
or necrotic tumors using diffusion-weighted and
apparent-diffusion coefficient images [9]. A prospec-
tive study [10] in 115 patients with 147 space
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 Brain abscesses Brouwer and van de Beek

(a) (b)

FIGURE 1. Brain MRI scans showing large abscess in patient presenting with an isolated change in behavior. Axial T2-
weighted (a) and gadolinium enhanced T1-weighted (b) MRI image of large abscess in the right frontal lobe. MRI, magnetic
resonance imaging.

occupying lesions of the brain including 97 patients
with brain abscesses showed that diffusion-
weighted imaging (DWI) had a 96% sensitivity
and specificity for the differentiation of brain
abscesses from tumors. A 2014 meta-analysis of 11
studies including 504 patients with 519 abscesses on
the value of DWI in brain abscess discrimination
showed a combined sensitivity of 95% (95% confi-
dence interval 0.87–0.98) and specificity of 95%
& &&
(95% confidence interval 0.88–0.97) [11 ]. Several
studies [12,13] assessed novel MRI techniques
including magnetic resonance spectroscopy and
cerebral blood volume measurement in the differ-
entiation between brain abscesses and malignan-
cies. However, it is unclear whether these
parameters perform better than common MRI with
DWI. Cranial imaging shows multiple abscesses in
21% of cases recently summarized in the meta-
&&
analysis of cohort studies (Fig. 2) [2 ].
Other diagnostic methods used in brain abscess
patients can provide evidence of an infection in
general, such as erythrocyte sedimentation rate,
blood leukocytosis or elevation in CRP, or of con-
comitant bacterial meningitis by means of cerebro-
&&
spinal fluid examination [2 ]. However, the blood
parameters of infection are within the normal
range in 30–40% and normal cerebrospinal fluid
leukocyte count is observed in 30%. Therefore,
these cannot be used to rule out that a lesion in
the brain is infectious. A lumbar puncture should
be performed with caution as in one large case
series 19% of patients deteriorated due to increasing
brain shift caused by the puncture of which 5%
died [14].
Identification of underlying infectious foci that
disseminated to the brain, resulting in brain abscess
formation, should be a priority in all patients in
whom the cause is not evident. This includes echo-
cardiography to rule out endocarditis, chest X-ray to
identify lung infections, evaluation of ear, nose, and
throat foci of infection (sinusitis, mastoiditis), and
the teeth [1 ]. In selected patients, fludeoxyglucose-
PET imaging may be indicated to identify distant
foci of infection [15]. Tooth extraction, cardiac valve
replacement, or sinus surgery may be indicated to
remove the focus of infection and prevent further
spread of the bacteria [16].
Identification of the pathogen is crucial to deter-
mine antibiotic susceptibility patterns and tailor
antibiotic treatment. To achieve pathogen identifi-
cation neurosurgery is essential. With the use of
volumetric CT or MRI combined with stereotactic
navigation a trajectory can be planned to aspirate
&&
the purulent center of the abscess [1 ,17]. Aspira-
tion of the abscess for diagnostic purposes should be
performed unless it is contraindicated because of the
suspected pathogen or the clinical condition of the
&&
patient [1 ]. For instance, in HIV-infected patients
with suspected toxoplasmosis, presumptive therapy
is justified when tests for antitoxoplasma immuno-
globulin G antibodies are positive without further
tissue-based diagnosis. When a single pathogen has
been cultured from blood or cerebrospinal fluid,
stereotactic aspiration of the abscess for diagnostic

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CNS infections
(a)
FIGURE 2. Examples of brain MRI scans showing multiple abscesses due to Streptococcus milleri (a) and Nocardia farcinica
(b). Axial gadolinium enhanced T1-weighted (a) and fluid-attenuated inversion recovery weighted MRI (b) showing multiple
abscesses, with perifocal edema. MRI, magnetic resonance imaging.
purposes may still be considered if polymicrobial
infection is suspected, for instance when a patient
does not respond to antibiotic treatment. Diagnos-
tic aspiration should always be aimed at achieving
maximal drainage to speed up recovery and some
suggest continuous drainage of the abscess post-
operatively through a catheter in the abscess may
decrease the reoperation rate [18]. Few studies, how-
ever, are available to assess the benefit of this
approach.
The microbiological investigation of the aspirate
of the abscess and, when acquired, cerebrospinal
fluid should include a Gram stain and both aerobic
&&
and anaerobic cultures [1 ]. In immunocompro-
mised patients or those with specific risk factors
such as a history of pulmonary tuberculosis or
opportunistic infection, smears and cultures should
be obtained for mycobacteria, fungi, and Nocardia
species, and a PCR for T. gondii should be performed.
TREATMENT
Because of the wide range of potential pathogen
brain abscesses, both Gram positive and Gram nega-
tive bacteria should be covered with the empiric
treatment. Therefore, all patients need to receive
an extended-spectrum cephalosporin (cefotaxime
or ceftriaxone) combined with metronidazole. The
meta-analysis of cohort studies showed that this
regimen was used as empiric treatment in the
majority (53%) of patients, while all other combi-
nations of treatment were used in less than 10% of
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(b)
&&
patients [2 ]. In immunosuppressed patients such
as transplant recipients and HIV-infected patients,
this needs to be supplemented with voriconazole,
and trimethoprim-sulfamethoxazole or sulfadiazine
to cover fungi, yeasts, and toxoplasmosis while
&&
awaiting further diagnostics [1 ]. A total of 16%
of patients included in the meta-analysis received
only antibiotic treatment without neurosurgical
&&
aspiration of the abscess [2 ]. The advised duration
of intravenous antimicrobial therapy in bacterial
&&
brain abscess patients is 6–8 weeks [1 ]. Observa-
tional data have been published on shorter
durations of treatment, including a recent retrospec-
tive study of 55 patients [19]. The authors used
thermal curve and MRI DWI imaging to determine
when to stop antibiotic treatment [19]. This resulted
in cessation of antibiotics after an average of 21 days
(range 10–64) after which abscesses recurred in two
patients and 66% of patients had a good outcome.
The British Society for Antimicrobial Chemotherapy
recommends just 1–2 weeks of intravenous therapy
for patients with bacterial brain abscess and when
the patient has a good clinical response, a change to
an appropriate oral regimen can be considered [20].
Oral treatment regimens can consist of ciprofloxa-
cin, metronidazole, and amoxicillin [21]. Retrospec-
tive studies showed that this approach can be
successfully applied in selected patients, but it
should not be considered as standard therapy [22].
Prolongation of antibiotic treatment is generally
advised as long as the abscess cavity is visible on
cranial MRI.
Volume 30  Number 1  February 2017

Whether neurosurgical treatment of brain
abscess other than for acquisition of the pathogen
should be performed depends on the location and
size of the abscess, the clinical condition of the
patient, and the chance of achieving successful
&&
decompression [1 ]. Few data are available that
can be used to provide a cut-off in size that should
be used to decide on whether the patient should be
operated or not [23]. Abscess diameter of 2.5 cm or
more has been suggested as an indication for surgi-
cal intervention, but solid data to support this size
are lacking [24]. Other indications for surgery inde-
pendent of the abscess’ size include impending
brain herniation or periventricular abscess location
&&
[1 ]. When abscesses are located superficially in the
cortex in noneloquent areas (referring to brain
regions critical for speech, movement, sensation,
and vision) complete resection could be considered.
A 2016 meta-analysis of studies comparing resection
to aspiration included 208 patients of whom 84 were
&
treated with aspiration and 124 with resection [25 ].
Patients undergoing resection had lower rates of
reoperation, higher rate of postoperative abscess
clearance, and neurological improvement after 1
month. However, the quality of included studies
was poor with all studies being retrospective and
&
there was certainty of publication bias [25 ]. There-
fore, no clear conclusion can be drawn from this
study. Nonetheless, resection can be considered in
selected patients, especially in patients in whom a
pathogen with slow or limited response to antibiotic
treatment is suspected, such as fungi, tuberculosis,
&&
Actinomyces, or Nocardia species [1 ].
ADJUNCTIVE TREATMENTS
Patients with brain abscess are often treated with
adjunctive corticosteroids. In the meta-analysis of
cohort studies, corticosteroids use was reported for
1611 of 9699 (17%) patients of whom 892 (55%)
received a form of corticosteroids, mostly dexa-
&&
methasone [2 ]. Corticosteroids often result in a
rapid improvement in the patient’s conditions
when there is perifocal edema surrounding the brain
abscess, but may result in reduced penetration of
antibiotics through the blood–brain barrier and
thereby prolong the duration of antibiotic treat-
ment. Therefore, corticosteroids are advised only
in patients in whom profound edema is causing
substantial brain shift that may lead to cerebral
&&
herniation [1 ].
Case series have reported on the use of hyper-
baric oxygen therapy to improve the resolution of
the brain abscess and shorten antibiotic treatment
duration [26,27]. An initial study in 13 patients
included in a 5-year period treated with stereotactic
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Brain abscesses Brouwer and van de Beek
aspiration followed by hyperbaric oxygen treatment
for 5 days showed no recurrences, but lacked a
control group [26]. A recent retrospective study from
Sweden included 40 patients in a 11-year period of
which half received hyperbaric oxygen treatment
and the other half did not [27]. Outcome was better
in the hyperbaric oxygen treatment group, but
indicators of disease severity such as Glasgow Coma
Scale score on admission were also better upon
admission, limiting the comparability of groups.
Furthermore, the basis for the decision when to apply
hyperbaric oxygen therapy or not was unclear [27].
Further studies are needed before hyperbaric oxygen
treatment can be considered as routine treatment.
COMPLICATIONS AND OUTCOME
During the clinical course a substantial proportion
of patients deteriorate, which may include a decline
in consciousness or an increased severity of neuro-
logical deficits. In these patients repeated brain
imaging is indicated to detect enlargement of the
abscess, hydrocephalus, or impending herniation.
One of the most severe complications of brain
abscess is rupture of the abscess into the ventricle,
resulting in acute ventriculitis and hydrocephalus. A
recent retrospective cohort showed that intraven-
tricular rupture of the abscess was associated with an
odds ratio of 5.50 for having an unfavorable out-
come [28]. Previously reported mortality rates in
patients with abscess rupture in the ventricular sys-
tem range from 27 to 85%. Because of enlargement
of the abscess, acute hydrocephalus, or impending
herniation 31% of brain abscess patients require
&&
renewed surgery [2 ]. Other frequent complications
of cerebral abscess include epilepsy, which occurs in
at least 25% of patients on or during admission. The
use of prophylactic anticonvulsant drugs has not
been evaluated in brain abscess, but in other space
occupying lesions in the brain this treatment was
not associated with decreased seizure rate [29].
Therefore, anticonvulsant treatment is not rou-
tinely indicated in patients with brain abscess.
Following improvement of cranial imaging and
microbiological technology, minimally invasive neu-
rosurgical procedure, and improved antibiotic treat-
ment the outcome of patients with brain abscess has
&&
gradually improved over the past 50 years [2 ].
Mortality has declined from 40% in 1960 to 15%
in 2010. The mortality in patients in whom stereo-
tactic aspiration was performed was reported to be
only 3%, which may in part be due to publication
&&
bias [2 ]. Currently, 70% of patients with brain
abscess have no or minimal neurologic sequelae,
although data on long-term functional and neuro-
&&
psychological evaluation are lacking [2 ].
www.co-infectiousdiseases.com 133
CNS infections
CONCLUSION
Brain abscess remains a relatively rare disease,
although few studies are available to assess the
incidence. In the recent literature, advances have
been made in describing the disease, ancillary inves-
tigations, and treatment, mostly by combining pre-
viously available literature and providing expert
&& && & &
opinions [1 ,2 ,11 ,25 ]. These overviews show
that the most frequent causes of brain abscess
include Staphylococcus and Streptococcus species,
which reach the brain by hematogeneous spread
or directly through sinus infection or following
trauma or neurosurgery. New developments in the
last years include the analysis of genetic risk factors
for brain abscess, use of shorter antibiotic courses,
&
and hyperbaric oxygen treatment [8 ,19,27]. How-
ever, few studies overcome methodological errors
and therefore cannot be used to guide clinical prac-
tice. Over the past 50 years there has been a gradual
improvement in outcome, which is thought to be
due to improved brain imaging, minimally invasive
neurosurgical procedures, and protocoled antibiotic
treatment. New multicenter prospective studies and
randomized clinical trials are needed to further
advance the treatment and prognosis in brain
abscess patients.
Acknowledgements
None.
Financial support and sponsorship
M.C.B. is supported by a grant from the Netherlands
Organization for Health Research and Development
(ZonMw; NWO-Veni grant 2012 [916.13.078]).
D.v.d.B. is supported by grants from the Netherlands
Organization for Health Research and Development
(ZonMw; NWO-Vidi grant 2010 [016.116.358]) and
the European Research Council (ERC Starting Grant
281156).
Conflicts of interest
There are no conflicts of interest.
REFERENCES AND RECOMMENDED
READING
Papers of particular interest, published within the annual period of review, have
been highlighted as:
& of special interest
&& of outstanding interest
1. Brouwer MC, Tunkel AR, McKhann GM 2nd, van de Beek D. Brain abscess. N
&& Engl J Med 2014; 371:447–456.
Review article providing current concepts on clinical presentation, diagnostics,
and treatment of brain abscesses.
2. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and
&& outcome of brain abscess: systematic review and meta-analysis. Neurology
2014; 82:806–813.
Meta-analysis of 123 cohort studies including 9699 brain abscess patients
describing causative organisms, clinical characteristics, ancillary investigations,
and outcome.
134 www.co-infectiousdiseases.com
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
3. Nicolosi A, Hauser WA, Musicco M, Kurland LT. Incidence and prognosis of
brain abscess in a defined population: Olmsted County, Minnesota, 1935–
1981. Neuroepidemiology 1991; 10:122–131.
4. Tunkel AR. Brain abscess. In: Bennett JE, Dolin R, Blaser M, editors.
Principles and practice of infectious diseases. 8th ed. Philadelphia: Elsevier;
2015. pp. 1265–1272.
5. Kastenbauer S, Pfister HW, Wispelwey B, Scheld WM. Brain abscess. In:
Scheld WM, Whitley RJ, Marra CM, editors. Infections of the central nervous
system. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004. pp. 479–
507.
6. Helweg-Larsen J, Astradsson A, Richhall H, et al. Pyogenic brain abscess, a
15 year survey. BMC Infect Dis 2012; 12:332.
7. Laulajainen-Hongisto A, Lempinen L, Farkkila E, et al. Intracranial abscesses
over the last four decades; changes in aetiology, diagnostics, treatment and
outcome. Infect Dis (Lond) 2015; 1–7. [Epub ahead of print]
8. Mishra P, Prasad KN, Singh K, et al. Association of ICAM-1 (K469E) and
& MCP-1-2518 A>G gene polymorphism with brain abscess. J Neuroimmunol
2016; 292:102–107.
First genetic association study in brain abscess patients.
9. Reddy JS, Mishra AM, Behari S, et al. The role of diffusion-weighted imaging in
the differential diagnosis of intracranial cystic mass lesions: a report of 147
lesions. Surg Neurol 2006; 66:246–250.
10. Gottlieb SL, Newbern EC, Griffin PM, et al. Multistate outbreak of Listeriosis
linked to turkey deli meat and subsequent changes in US regulatory policy.
Clin Infect Dis 2006; 42:29–36.
11. Xu XX, Li B, Yang HF, et al. Can diffusion-weighted imaging be used to
& differentiate brain abscess from other ring-enhancing brain lesions? A meta-
analysis. Clin Radiol 2014; 69:909–915.
Meta-analysis of diagnostic studies using MRI in brain abscess patients.
12. Hsu SH, Chou MC, Ko CW, et al. Proton MR spectroscopy in patients with
pyogenic brain abscess: MR spectroscopic imaging versus single-voxel
spectroscopy. Eur J Radiol 2013; 82:1299–1307.
13. Toh CH, Wei KC, Chang CN, et al. Differentiation of brain abscesses from
glioblastomas and metastatic brain tumors: comparisons of diagnostic per-
formance of dynamic susceptibility contrast-enhanced perfusion MR imaging
before and after mathematic contrast leakage correction. PloS One 2014;
9:e109172.
14. Nadvi SS, Nathoo N, van Dellen JR. Lumbar puncture is dangerous in
patients with brain abscess or subdural empyema. S Afr Med J 2000;
90:609–610.
15. Sato J, Kuroshima T, Wada M, et al. Use of FDG-PET to detect a chronic
odontogenic infection as a possible source of the brain abscess. Odontology
2016; 104:239–243.
16. Lucas MJ, Brouwer MC, van der Ende A, van de Beek D. Endocarditis in adults
with bacterial meningitis. Circulation 2013; 127:2056–2062.
17. Barlas O, Sencer A, Erkan K, et al. Stereotactic surgery in the management of
brain abscess. Surg Neurol 1999; 52:404–410.
18. Shen H, Huo Z, Liu L, Lin Z. Stereotactic implantation of Ommaya reservoir in
the management of brain abscesses. Br J Neurosurg 2011; 25:636–640.
19. Xia C, Jiang X, Niu C. May short-course intravenous antimicrobial adminis-
tration be as a standard therapy for bacterial brain abscess treated surgically?
Neurol Res 2016; 38:414–419.
20. de Louvois J, Brown EM, Bayston R, et al. The rational use of antibiotics in the
treatment of brain abscess. Br J Neurosurg 2000; 14:525–530.
21. Skoutelis AT, Gogos CA, Maraziotis TE, Bassaris HP. Management of brain
abscesses with sequential intravenous/oral antibiotic therapy. Eur J Clin
Microbiol Infect Dis 2000; 19:332–335.
22. 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;
26:1–11.
23. Rosenblum ML, Hoff JT, Norman D, et al. Nonoperative treatment of brain
abscesses in selected high-risk patients. J Neurosurg 1980; 52:217–
225.
24. Mamelak AN, Mampalam TJ, Obana WG, Rosenblum ML. Improved manage-
ment of multiple brain abscesses: a combined surgical and medical approach.
Neurosurgery 1995; 36:76–85.
25. Zhai Y, Wei X, Chen R, et al. Surgical outcome of encapsulated brain abscess
& in superficial non-eloquent area: a systematic review. Br J Neurosurg 2016;
30:29–34.
Systematic review of studies comparing aspiration vs. resection of superficial brain
abscesses in no-eloquent regions.
26. Kutlay M, Colak A, Yildiz S, et al. Stereotactic aspiration and antibiotic
treatment combined with hyperbaric oxygen therapy in the management of
bacterial brain abscesses. Neurosurgery 2008; 62 (Suppl 2):540–546.
27. Bartek J Jr, Jakola AS, Skyrman S, et al. Hyperbaric oxygen therapy in
spontaneous brain abscess patients: a population-based comparative cohort
study. Acta Neurochir (Wien) 2016; 158:1259–1267.
28. Tunthanathip T, Kanjanapradit K, Sae-Heng S, et al. Predictive factors of the
outcome and intraventricular rupture of brain abscess. J Med Assoc Thai
2015; 98:170–180.
29. Tremont-Lukats IW, Ratilal BO, Armstrong T, Gilbert MR. Antiepileptic drugs
for preventing seizures in people with brain tumors. Cochrane Database Syst
Rev 2008; 2:CD004424.
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