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Vol. 3. Issue 2.
Pages 125-130 (January 1992)
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Vol. 3. Issue 2.
Pages 125-130 (January 1992)
Absceso cerebral. Revisión de 60 casos
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J.M. Ortega, R. Díez Lobato, J.M. Aguado, J. Domínguez, J. Ayerbe, H. Sandoval, J.J. Rívas
Servicio de Neurocirugía. Hospital «12 de Octubre». Madrid
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Resumen

A pesar de los progresos en la terapia antibiótica y las técnicas radiológicas, la mortalidad del absceso cerebral es todavía importante, y su incidencia, lejos de disminuir, parece estar aumentando.

Analizamos 60 casos de absceso cerebral recogidos en nuestro Servicio entre 1974 y 1990. Las infecciones óticas y pulmonares fueron identificadas como factores predisponentes en el 30% y 12% de los casos, respectivamente. El origen de la infección no se encontró en el 35% de los pacientes.

La cefalea, la fiebre, el defecto focal y las alteraciones del nivel de conciencia fueron los síntomas de presentación más frecuentes.

El 75% de los pacientes se trataron después de la introducción de la tomografia computadorizada (TC), con un 80% de aciertos en la sospecha diagnóstica y dos días de demora entre ingreso y tratamiento. El 25% restante se manejaron antes de la era Tc, con un 50% de aciertos y ocho días de demora.

Las localizaciones más frecuentes fueron la temporal y la frontal. En el 10% de los casos los abscesos fueron múltiples. Los cultivos del pus obtenido resultaron positivos en un 75% de los casos, y los anaerobios fueron los gérmenes hallados con más frecuencia.

La mortalidad con la técnica de punción-aspiración, introducida después de la llegada de la TC, fue del 15%, mientras que con la extirpación mediante craneotomía, utilizada fundamentalmente antes de la década de los ochenta, la mortalidad fue del 50%.

Los factores pronósticos más importantes fueron la alteración del nivel de conciencia previo a la cirugía y el número de abscesos.

Palabras clave:
Absceso cerebral
tomografía computadorizada
punción-aspiración
Summary

Despite improvements in antibiotic therapy and radiologic diagnosis, mortality caused by brain abscesses is still high, and its incidence, far from decreasing, may be rising.

We analyze 60 cases of brain abscess treated between 1974 and 1990. Otic and lung infections were identified as predisposing factors in 30% and 12% of the cases respectively.

The origin of the infection was not found in the remaining 35% of the cases.

Headache, fever, focal deficit and alterations in the level of consciousness were most frequent initial symptoms.

Seventy five per cent of our patients were treated after computerized tomography (CT) introduction, when correct diagnosis was made in 80% of the cases and the average delay between admission and treatment was two days. The reamining 25% of the cases were managed during the pre-CT period, when preoperative diagnosis was made in 50% of these cases and the average delay between admission and treatment reached eight days.

Temporal and frontal locations were the most frequent and in 10% of the cases the abscesses were multiple. Pus cultures were positive in 75% of the total sample, and anaerobes were the most commonly found germs.

The mortality rate with the aspiration surgical technique, which was introduced after CT available, was 15%, whereas it was 50% with conventional surgical excision, which was mainly used before the 1980s.

The most significant prognostic factars were the level of consciousness before the operation and the number of abscesses.

Key words:
Brain abscess
computerized tomography
aspiration

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