BRAIN-ABSCESS AND SUBDURAL EMPYEMA

Notable contributions have been made recently in the diagnosis and management of brain abscesses and subdural empyema. Several articles present an international perspective, echoing much of the Western literature, including a profound decrease in mortality with the availability of computed tomography and early recognition and treatment. Diagnostic studies have highlighted the superiority of magnetic resonance imaging to computed tomography in the detection of subdural empyema and the potential value of positron emission tomography. Novel diagnostic tools, including Tc-99m-hexamethylpropyleneamine oxime leukocyte scintigraphy and C-reactive protein levels, have been evaluated and show great promise. Surgical studies comparing stereotactic drainage with craniotomy for brain abscesses and burr hole versus craniotomy drainage of subdural empyema suggest the efficacy of these more limited procedures. Local instillation of antibiotics is a potentially effective adjunct for refractory brain abscesses. Recent studies suggest that the most significant predictors of poor outcome are the patient's level of consciousness and the rapidity of disease progression prior to the initiation of treatment.