Morbidity Mortality

Intracranial abscesses (i.e. cerebral abscess, epi- and subdural empyema) account for not more than 3 to 5 admissions per year even at larger medical centers2. Thus, the incidence is low and roughly in the same range as that of e.g. gas gangrene in former years.

However, the overall mortality described in numerous series from different countries around the world for the years 1981 to 2005 (table 2.2.51) varies from 0 to 36 %, averaging at 19.2 %! Even if the mortality has significantly decreased over the past three decades to about 13 % at present, it still remains unacceptably high.

Table 2.2.5-1. Mortality rates from intracranial abscesses treated by means of standard management (time span studied: 1981-2005 [year of publication]) 1981 - 1986

Author

Published

Country of Origin

Nb

Deaths

Mortality

[Ref.]

Yang

1981

PR China

400

91

23 %

3

Alderson

1981

Great Britain

90

9

10 %

4

Dohrmann

1982

Australia

28

10

36 %

5

Britt

1983

USA

14

5

36 %

6

Cowie

1983

Great Britain

89

24

27 %

7

Harris

1985

USA

15

3

20 %

8

636

142

22.3 %

1987 - 1993

Author

Published

Country of Origin

Nb

Deaths

Mortality

[Ref.]

Ferriero

1987

USA

17

1

6 %

9

Pattisapu

1987

USA

8

0

0 %

10

Miller

1988

Great Britain

100

20

20 %

11

Schliamser

1988

Sweden

54

17

31 %

12

Basit

1989

Saudi-Arabia

21

5

24 %

13

Szuwart

1989

Germany

38

10

26 %

14

Witzmann

1989

Austria

38

7

18 %

15

Pathak

1990

lndia

41

10

24 %

16

Kratimenos

1991

Great Britain

14

2

14 %

17

Mclntyre

1991

Australia

14

3

21 %

18

Bagdatoglu

1992

Turkey

78

16

20 %

19

Seydoux

1992

Switzerland

39

5

13 %

20

Bok

1993

South-Africa

21

5

24 %

21

Stapleton

1993

Great Britain

11

3

27 %

22

Yang

1993

PR China

140

11

8 %

23

634

115

18.1 %

Author

Published

Country of Origin

Nb

Deaths

Mortality

[Ref.]

Sharma

1995

lndia

38

12

32 %

24

Takada

1998

Japan

13

0

0,0 %

25

Stephanov

1999

Switzerland

17

2

11,8 %

26

Mamatova

2000

Uzbekistan

13

1

7,6 %

27

Liliang

2001

Taiwan

15

4

26,7 %

28

Marchiori

2003

ltaly

20

1

5 %

29

Jansson

2004

Sweden

66

3

4,5 %

30

Ozkaya

2005

Turkey

25

4

16 %

31

207

27

13.0 %

No. of series

Nb

Deaths

Mortality

29

1477

284

19.2 %

The factors responsible for a decreasing mortality certainly include:

• earlier and more accurate diagnosis by means of modern imaging,

• options of minimally invasive surgery, e.g. CT-guided fine needle aspiration,

• better knowledge of the bacteriological origins of intracerebral abscesses, resulting in a improved selection of antibiotics.

Nevertheless, one out of eight patients still die due to intracranial abscesses, and a high percentage of survivors suffer from severe neurological sequelae, mainly of epileptic origin7.

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