Post-traumatic brain abscess: experience of 36 patients

Thirty-six patients with post-traumatic brain abscess were managed over 18 years. They constituted 9.3% of all brain abscesses encountered during the same period. The head injury was associated with an external compound fracture in 20, internal compounding in three and was closed in 13 patients. The mean interval between the time of injury to presentation with an abscess was 113 days. This did not differ significantly in patients with closed and compound head injury, and amongst patients who had wound sepsis and with clean wounds after the injury. The occurrence of focal neurological deficit was more frequent in patients with a closed injury ( p0.05). Twenty patients underwent primary excision of the abscess with recurrence of the abscess in one patient. Of the 14 patients in whom the abscess was initially aspirated, eight patients required a subsequent excision. Excision was required in 18 patients (94.7%) with external compound injury, five (50%) of those with closed injury and in all patients with internally compound injuries. Two patients had 'coned' and died before they could be operated upon. The operative mortality in the absence of signs of herniation preoperatively was 12.5% in patients with compound injury and none among patients with closed head injury.