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Park and Sin: Clinical Characteristics, Risk Factor and Outcome of Brain Abscess: A Retrospective Analysis During a 10-year Period

Abstract

Background

This study aimed to collect and analyze the information of patients diagnosed with primary brain abscess at our hospital over the last 10 years to determine the predisposing risk factors, clinical characteristics, and predictors of outcome.

Methods

The retrospective study evaluated hospital records and radiology data of patients diagnosed with and treated for brain abscess in our hospital from 2013 to 2022. A total of 25 patients were included in this study. Clinical characteristics of patients diagnosed with brain abscess were identified, and the surgical group and the non-surgical group were compared and the risk factors for poor prognosis were investigated. In addition, the excision and aspiration groups were compared among patients who underwent surgical treatment.

Results

Seventeen patients (68%) underwent surgery, and the remaining eight patients (32%) underwent conservative treatment. Of the 17 patients who underwent surgery, nine patients (52.94%) underwent stereotactic drainage, and eight (47.05%) underwent craniotomy, and excision. At discharge, nine patients (36%) had poor outcomes (modified Rankin Scale score 3-6), including one (5.88%) who died, and the remaining 16 (68%) had good outcomes (mRS score 0-2).

Conclusion

The most common comorbidity in the patients with brain abscess was diabetes mellitus, and Gram-positive Staphylococcus was the most common pathogen. Headache and confusion are also associated with poor outcomes. In addition, aspiration and excision had no significant differences in terms of outcomes

INTRODUCTION

Brain abscess is an intraparenchymal accumulation of pus. It begins with localized areas of cerebritis in the parenchyma and evolves into collections of pus enclosed in a well-vascularized capsule. It may occur as a result of spread from a contiguous focus of infection or may be of unknown origin. The reasons why brain abscess occurs include predisposing factors, such as underlying disease, a history of immunosuppressive drugs, disruption of the protective barrier surrounding the brain (e.g., neurosurgical procedure, head trauma), or a systemic source of infection (endocarditis or bacteremia)1). To manage patients with cerebral abscesses successfully, the infectious process is to be eliminated with an appropriate antimicrobial agent and the mass effect should be reduced using drainage or excisional procedures, thus avoiding or minimizing secondary cerebral injury and neurological deficit. Surgical excision or aspiration combined with prolonged antimicrobial therapy remains the treatment of choice. However, some factors should be considered when choosing the appropriate treatment. This study aimed to collect and analyze the information of patients diagnosed with primary brain abscess at our hospital over the last 10 years to determine the predisposing risk factors, clinical characteristics, and predictors of outcome.

MATERIALS AND METHODS

The retrospective study evaluated hospital records and radiology data of patients diagnosed with and treated for brain abscess in our hospital from 2013 to 2022. The study was approved by the Institutional Review Board (IRB) of Konyang University Hospital (No.2023-03-029). Patients who met at least one of the following criteria were included: (1) evidence of infection in brain specimens collected from surgical aspiration or excision and (2) brain magnetic resonance imaging (MRI) and/or computed tomography (CT) findings of brain abscess and reversal of brain lesions with antibiotic therapy. Patients with intracranial empyema, including those with subdural and epidural abscess, were excluded. The following factors were analyzed in all patients: age, sex, predisposing factors, location and volume of the brain abscess, initial neurological status, biological organisms, surgical procedures, duration and type of antibiotic therapy, and neurological outcomes. The neurological status of the patients was assessed on admission via physical examination. Brain abscess volume (mm3) was calculated using the formula 0.5×X×Y×Z, where X, Y, and Z are the largest diameters of the abscess in the X-, Y-, and Z-axes, respectively. If multiple brain abscesses were present, the largest was measured.
We conducted standard laboratory tests, including complete blood counts, c-reactive protein levels, blood and cerebrospinal fluid (CSF) cultures, and serum chemistry. Imaging diagnostic tools include enhanced CT and MRI. Stereotactic navigation-guided aspiration and resection via craniotomy were performed under general anesthesia. Empirical antibiotic treatment was initiated after diagnosis in all cases. All patients were administered intravenous antibiotics for 4–8 weeks. Factors, such as predisposing conditions, result of antibiotic susceptibility test, patient treatment response, as noted clinically and radiologically, and inflammatory laboratory parameters, were the main determinants of antibiotics. Follow-up CT imaging was performed within 24 h of the surgical procedure and weekly as part of therapeutic monitoring. At these time intervals, white and red blood cell counts and C-reactive protein levels were also monitored. Outcomes were assessed in all patients according to modified Rankin Score scores. A score of 3–6 was regarded as a poor outcome, and a score of 0–2 was regarded as a good outcome, indicating that the patient was independent in daily life.
Statistical analyses were performed using IBM SPSS 22.0. Continuous data were expressed as means±standard deviation or median and were analyzed using the independent t-test or Mann–Whitney U test. Categorical data were analyzed using the Chi-squared test. Multivariate logistic regression analysis was performed to identify factors affecting the outcome. Statistical significance was set at p <0.05.

RESULTS

Clinical characteristics

Twenty-five patients were diagnosed with brain abscess during the study period (Table 1). The mean age was 66.32±13.05 years (range 34–93). Sixteen patients (64%) were males, and nine patients (36%) were females. The mean duration of hospitalization was 50.48±12.3 days, and the median symptom duration at admission was 8 days. The patients’ symptoms at admission included headache (n=13, 52%), hemiplegia (10) (40%), fever (7) (28%), confusion (7) (28%), nausea and vomiting (3) (12%), seizure (3) (12 %), aphasia (5) (20%), dizziness (4) (16%), neck stiffness (2) (8%), and sore throat (1) (4%). At the time of hospitalization, fifteen patients (60%) were Good (mRS≤2), eight patients (40%) were poor (mRS>2). Sixteen patients (64%) showed improvement in mRS Score by more than 2 points at the time of discharge, and nine patients (36%) showed deterioration, including one death.

Predisposing factors and comorbidities

The most common predisposing factor in our cohort was the neurosurgical procedure (n=8, 32%) (Table 1). Other predisposing factors included hematogenous infections, such as pneumonia, upper respiratory infection, urinary tract infection, liver abscess, viral infection (6, 24%), and adjacent infections, such as dental infection and sinusitis (5, 20%). Head trauma history (4, 16%), periodic injection drug (2, 8%), and immunosuppression, (1, 4%) were also investigated. The patients’ comorbidities included immunocompromising diseases, such as diabetes mellitus (10, 40%), hypertension (9, 36%), Malignancy (2, 8%), liver cirrhosis (1, 4%), stroke (1, 4%), and human immunodeficiency virus (1, 4%).

Laboratory findings

Fourteen patients (56%) had elevated white blood cell counts (>10.8 ×103 /uL), and fifteen patients (60%) had shown c-reactive protein elevation (>0.5mg/dL) on peripheral blood testing. Blood cultures were performed in eight patients (32%), and positive results were obtained in two (8%) of them; in addition, bacteria of the streptococcus anginosus and Enterococcus faecalis were isolated from each patient. Lumbar puncture was performed in 10 patients (40%), and an increased cell count (>5 ×106 cells/L) was observed in the CSF of 7 patients (70%). Eight patients showed CSF protein levels greater than 50mg/dL. CSF culture was performed in 10 patients (40%), and positive results were obtained in two of them (20%); in addition, Staphylococcus aureus and E. faecalis were isolated from each patient. Culture of the intracerebral specimens obtained during surgery was performed in 17 patients (68%), and positive results were obtained in 10 of them (58.82%). Organisms from brain abscess material cultures are shown in Table 2.

Neuroimaging findings

Twenty patients (80%) had a single abscess, and five patients (20%) had multiple abscesses. The abscess was located in the frontal lobe in nine patients (36%), the parietal lobe in eight patients (32%), the temporal lobe in five patients (20%), the occipital lobe in one patient (4%), the basal ganglia in three patients (12%), and brainstem in one patient (4%). The median abscess volume was 15.24 cm3 (95% confidence interval 10.37–19.52 with small (<1 cm3), medium (1–10 cm3), and large (> 10 cm3) lesions in two (8 %), ten (20%), and thirteen (52%) patients, respectively.

Treatment and outcome

Initial empirical antibiotic therapy included ceftriaxone, metronidazole, vancomycin, or a combination of these drugs, and was adjusted according to the results of sensitivity testing. The mean duration of antibiotic therapy was 46.34±12.31 days. Surgical treatment was performed if there was a signature mass effect exerted by lesion or poor neurological deficit due to increased intracranial pressure. Seventeen patients (68%) underwent surgery, and the remaining eight patients (32%) underwent conservative treatment. Table 3 shows the comparison of patients with and without surgery, and significant differences in abscess volume (p=0.016) and some symptoms at admission, including headache (p=0.011) or hemiplegia (p=0.003), were observed between the two groups. At discharge, eight patients (32%) had poor outcomes, including one (5.88%) who died, and the remaining 17 (68%) had good outcomes. Multivariate analysis was performed to identify factors associated with poor outcomes. Headache (p=0.015, 95% Confidence Interval 1.774–88.069) and confusion (p=0.006 95% Confidence Interval 1.722–63.558) are independently associated with poor outcomes (Table 4). Of the 17 patients who underwent surgery, nine patients (52.94%) underwent stereotactic drainage, and eight (47.05%) underwent craniotomy, and excision (Table 5).

DISCUSSION

The average age of the study participants was 66 years, and 44% of them were aged more than 65 years. This is inconsistent with previously published reports associated with the age predilection of brain abscess. Some studies showed that individuals older than 40 years are more susceptible to brain abscess2,3,4), whereas others revealed that brain abscess occurs more often in individuals younger than 40 years5,6). The average age of participants in a meta-analysis conducted in 2014 was 33.6 years7). Therefore, it is considered difficult to determine the most affected age group.
Twenty-one (84%) patients suffering from brain abscess had some predisposing factors. The neurosurgical procedure was the most common predisposing factor. When the blood-brain barrier is damaged, the brain becomes extremely vulnerable to bacterial infections. Each of the five patients (20%) experienced infection in adjacent areas, such as sinusitis, chronic otitis media, and dental or hematogenous infection. Most patients with brain abscess have predisposing conditions, which may provide clues toward causative micro-organisms8). The contagious spread of bacteria occurs in half of the cases and can result from penetrating trauma, neurosurgery, or infections1,8). Comorbidities, including diabetes mellitus, hypertension, tumor, liver cirrhosis, and a history of stroke, were noted in 72% of the patients in our cohort. Diabetes mellitus was the most common comorbidity observed in this study. The relationship between diabetes mellitus and susceptibility to infection has been reported9). Impaired glucose control may affect host defense and increase the risk of brain abscess. Our study differs from the previous reports. Other reports explained that a history of stroke was reported to be a common comorbidity, as damaged brain tissues might be vulnerable to invasion by infectious organisms10). Other comorbidities, including human immunodeficiency virus infection, autoimmune disease, and immunosuppressive therapy, were reported in a previous study11). However, only a few patients had these comorbidities.
The clinical presentation of brain abscess depends on the site, size, number of lesions, and any secondary cerebral injuries. Similar to previous study12), our cases were also frequently presented with classical symptom triad of this disease, such as headache, fever, and hemiplegia in our study, occurring in 52%, 40%, and 28% of the patients, respectively. The symptoms were atypical, and the absence of this classical clinical triad decreased the likelihood of brain abscess being suspected on initial examination. In addition, the advancement of MR technology, including perfusion- and diffusion-weighted images and MR spectroscopy, has made a more accurate diagnosis of cerebral abscess and differentiation from other ring-enhancing lesions possible13,14). Sixty percent of the patients in this study had an elevated peripheral white blood cell count. Indicators of inflammation, such as white blood cell count and c-reactive protein level, were useful indicators of clinical response to treatment, but not helpful in diagnosing brain abscess or in predicting outcome due to another infection in which the patient is present15). An increased cell count in the CSF, which indicates leptomeningeal infection, was observed in 70% of the patients who underwent lumbar puncture in this study, and this finding helped us determine the nature of the brain lesion in those patients. However, not all patients with brain abscess show leptomeningeal involvement, and the role of lumbar puncture in diagnosis is limited.
The rate of brain abscess purulent material culture positivity in our study was 48%, which is far lower than the previously reported rate of approximately 70%7,16). This may be because we initiated antibiotic therapy before obtaining samples for culture, and the standard culture protocol followed at our hospital may result in certain organisms being undetected. In addition, operations in the referral cases from other non-neurosurgical departments were delayed. In our study, gram-positive Staphylococcus was the most common pathogen observed in the material culture of brain abscesses. In previous studies, the most commonly observed bacteria in patients with brain abscesses were those of the Streptococcus species from 1952 to recent days15). With the development of culture techniques and microbiological analysis, the trend is toward a high incidence of infection with polymicrobial and gram-negative organisms in today’s causative organism17,18).
The most common brain abscess location in our study was the frontal lobe, followed by the parietal and parietal lobes. Most patients had single lesions. This result is consistent with a previous report1,3). However, another study found that the temporoparietal region is the most common brain abscess location19). The location of a brain abscess partly depends on the route of infection transmission20). Brain abscesses related to direct spread from sinus or odontogenic foci tend to be frontal and are caused by aerobic or anaerobic streptococci, Enterobacteriaceae, Staphylococcus aureus, and anaerobes. An abscess secondary to an otic infection is usually temporal or cerebellar, with mixed flora, including anaerobes and streptococci (aerobic and anaerobic), Enterobacteriaceae, and Pseudomonas aeruginosa.
The treatment of brain abscesses is aimed at reducing space-occupying activity, lowering intracranial pressure, and eradicating pathogenic microorganisms; thus, brain abscess is basically a surgical lesion. Surgery allows the immediate reduction of intracranial pressure from a mass effect and the identification of the causative organism. In addition, surgical treatment by aspiration or excision is more likely to lead to shorter treatment and decrease the possibility of serious clinical deterioration With intraventricular rupture. However, recently, there have been a few reports demonstrating successful non-operative treatment of brain abscess with antibiotics alone12,15). The cerebritis phase refers to abscesses in an early stage of formation, in which there is inward migration of leukocytes and significant secondary edema, but no well-formed fibrous capsule. Therefore, these abscesses are usually observed in the first 0–9 days of development21,22), and because they are not encapsulated, antibiotic therapy is more likely to provide adequate therapy without surgery23-25). In our study, 68% of the patients underwent surgery. We observed a significant difference in abscess volume between patients with and without surgery; however, no difference was observed in the number of abscesses. A previous study showed that the number or size of abscesses or midline shifts may affect the decision for surgical therapy10). Patients with headaches or hemiplegia were significantly more likely to undergo surgery. When these symptoms are visible, families tend to make more surgical decisions to improve their quality of life.
In choosing between aspiration or excision, the choice of procedure remains controversial26,27). Several reports have advocated excision as the procedure of choice because it is often followed by a lower incidence of recurrence and shorter hospitalization28-30). Recently, based on their good treatment outcome with craniotomy and lesionectomy, they recommended that indication for early surgical excision of brain abscess are single, accessible, superficial, and larger lesion accompanying aggravated neurological deficit31). However, recent studies indicated that the stereotactic management of brain abscess allow both confirmation of the diagnosis and institution of therapy by the aspiration of its contents and identification of the offending organism, which has become primarily widespread with the introduction of CT-guided stereotaxy6,29,32). In our cohort study, there was no significant difference between the excision and aspiration groups (Table 5). A previous study found no difference in the effects, outcomes, and complications of these two surgical techniques3). Xiao et al.15) also reported that favorable outcome was not significantly different between the patient treated by excision or aspiration. These varying results could be considered that the aspiration group may be associated with more multiple abscesses and poor general conditions, whereas the excision group may have a more favorable abscess position that can be completely removed by craniotomy and a good general condition.
Previous studies have reported inconsistent findings regarding the factors associated with outcomes. Age, immunosuppression, and hematogenous spread were found to be associated with a poor outcome in brain abscess patients2). Meanwhile, it was revealed that sex was associated with an unfavorable outcome3). Another study found that consciousness at presentation had prognostic value19). In our study, headache and confusion influenced outcomes. As a classical symptom of brain abscesses, headache indicates possible intracranial hypertension, which may lead to a poor outcome. A confused mentality can lead to a poor prognosis because it suggests high intracranial pressure. This study has several limitations. The sample size is small. In addition, this was a retrospective single-center study. Therefore, our findings may not be generalizable to patients in different regions, and some data could not be collected or analyzed. Multicenter studies with larger sample sizes are warranted.

CONCLUSION

The most common comorbidity in the patients with brain abscess included in this study for over 10 years was diabetes mellitus, and Gram-positive Staphylococcus was the most common pathogen. Headache and confusion are also associated with poor outcomes. In addition, aspiration and excision had no significant differences in terms of outcomes.

NOTES

Ethics statement

The study was approved by the Institutional Review Board (IRB) of Konyang University Hospital (No.2023-03-029).

Author contributions

Conceptualization, Methodology: All authors. Data curation, Formal analysis, Investigation, Resources, Writing – original draft: JSP. Supervision, Validation, Writing – review & editing: EGS.

Conflict of interest

There is no conflict of interest to disclose.

Funding

None.

Data availability

None.

Acknowledgements

None.

Table 1.
Demographic characteristics of patients treated for brain abscess
Characteristics Number of patients (%) (n=25)
Sex
 M 16 (64)
 F 9 (36)
Age
 <65 14 (56)
 ≥65 11 (44)
Comorbidities
 Diabetes mellitus 10 (40)
 Hypertension 9 (36)
 Malignancy 2 (8)
Human immunodeficiency virus 1 (4)
 Old stroke 1 (4)
 Liver cirrhosis 1 (4)
 Others 10 (40)
Predisposing factors
 Neurosurgical procedure 8 (32)
 Hematogenous infection 6 (24)
 Contiguous spread 5 (20)
 Head trauma 4 (16)
 Periodic injection drug 2 (8)
 Immunosuppression 1 (4)
Symptoms and signs.
 Headache 13 (52)
 Fever 5 (20)
 Confusion 7 (28)
 Hemiplegia 8 (32)
 Nausea and vomiting 2 (8)
 Seizure 2 (8)
 Dysarthria 5 (20)
White blood cell count
 <10.8×103 /uL 11 (44)
 ≥10.8×103 /uL 14 (56)
C-reactive protein
 ≥0.5mg/dL 15 (60)
 <0.5mg/dL 10 (40)
Number of abscess
 Solitary 20 (80)
 Multiple 5 (20)
Location of abscess
 Frontal lobe 7 (28)
 Temporal lobe 6 (24)
 Parietal lobe 7 (28)
 Occipital lobe 1 (4)
 Basal ganglia 2 (8)
 Brain stem 1 (4)
Volume of abscess
 <1 cm3 2 (8)
 1-10 cm3 10 (40)
 >10 cm3 13 (52)

M: Male, F: Female.

Table 2.
Organisms isolated from brain abscess culture specimens
Sex Age Culture specimen Organism
M 67 Intracranial purulent material Staphylococcus epidermis
M 60 Intracranial purulent material, blood Streptococcus anginosus
F 86 Intracranial purulent material Escherichia coli
M 47 Intracranial purulent material, blood, CSF Enterococcus faecalis
M 88 Intracranial purulent material Viridans streptococcus
F 87 Intracranial purulent material Streptococcus milleri
M 60 Intracranial purulent material Staphylococcus aureus
F 93 CSF Staphylococcus aureus
M 54 Intracranial purulent material Staphylococcus aureus
F 51 Intracranial purulent material Streptococcus intermedius
M 53 Intracranial purulent material Citrobacter koseri

M: Male, F: Female, CSF: Cerebrospinal fluid.

Table 3.
Comparison of patients with or without surgery
Surgery (%) No surgery (%) Total p-value
No of Pts 17 (68.0) 8 (32.0) 25
Sex
 M 12 (70.6) 4 (50.0) 16 0.394
 F 5 (29.4) 4 (50.0) 9
Age
 <65 10 (58.8) 4 (50.0) 14 1.000
 ≥65 7 (41.2) 4 (50.0) 11
Comorbidities 11 (64.7) 5 (62.5) 16 1.000
 Headache 12 (70.6) 1 (16.7) 13 0.011
 fever 4 (23.5) 2 (33.3) 6 1.000
 confusion 5 (29.4) 3 (50.0) 8 1.000
 hemiplegia 6 (35.3) 3 (50.0) 9 0.003
Nausea, vomiting 3 (7.6) 0 3 0.527
 seizure 2 (11.8) 1 (16.7) 3 1.000
 dysarthria 4 (23.5) 1 (16.7) 5 1.000
White blood cell count 1.000
 <10.8×103 /uL 7 (41.2) 3 (37.5) 10
 ≥10.8×103 /uL 10 (58.8) 5 (62.5) 15
Number of abscess 1.000
 solitary 14 (82.4) 6 (75.0) 20
 multiple 3 (17.6) 2 (25.0) 5
Location of abscess 0.734
 frontal lobe 6 (35.3) 3 (37.5) 9
 temporal lobe 4 (23.5) 1 (12.5) 5
 parietal lobe 4 (23.5) 4 (50.0) 8
 occipital lobe 1 (5.9) 0 1
 basal ganglia 2 (11.8) 0 2
 brain stem 0 1 (12.5) 1
Volume of abscess 0.016
 <1cm3 1 (5.9) 1 (12.5) 2
 1-10 cm3 4 (23.5) 6 (75.0) 10
 >10cm3 12 (70.6) 1 (12.5) 13

M: Male, F: Female.

Table 4.
Risk factors related to functional outcome in brain abscess patients
good outcome (%) Poor outcome (%) Total No P-value P, Regression (OR*, 95% CI*)
No of Pts 17 8 25
Sex 0.071
 M 13 (76.5) 3 (37.5) 16
 F 4 (23.5) 5 (62.5) 9
age 0.395
 <65 12 (70.6) 2 (25) 14
 ≥65 5 (29.4) 6 (75) 11
Comorbidities 11 (73.3) 5 (62.5) 16 0.657
 Headache 11 (78.6) 2 (25) 13 0.039 0.015 (12.359, 1.774-88.069)
 fever 3 (21.4) 2 (25) 5 1
 confusion 1 (7.1) 6 (75) 7 0.002 0.006 (20.458, 1.722-63.558)
 hemiplegia 5 (35.7) 3 (37.5) 8 1
 Nausea and vomiting 2 (14.3) 0 2 0.526
 seizure 1 (7.1) 1 (12.5) 2 1
 dysarthria 2 (14.3) 3 (37.5) 5 0.297
White blood cell count 0.086
 <10.8×103 /uL 10 (53.3) 1 (12.5) 11
 ≥10.8×103 /uL 7 (46.7) 7 (87.5) 14
Number of abscess 0.103
 solitary 15 (93.3) 5 (62.5) 20
 multiple 2 (6.7) 3 (37.5) 5
Location of abscess 0.59
 frontal lobe 5 (33.3) 2 (25) 7
 temporal lobe 5 (33.3) 1 (12.5) 6
 parietal lobe 3 (20) 4 (50) 7
 occipital lobe 1 (6.7) 0 1
 basal ganglia 1 (6.7) 1 (12.5) 2
 brain stem 1 (12.5) 1
Volume of abscess 0.788
 <1cm3 2 (11.8) 0 (37.5) 2
 1-10 cm3 7 (41.2) 3 (62.5) 10
 >10cm3 8 (47) 5 (75) 13
 Surgical treatment 11 (64.7) 6 (25) 17 0.331
 Conservative treatment 6 (35.3) 2 8

M: Male, F: Female, OR: Odds Ratio, CI: Confidence interval.

Table 5.
Comparison of aspiration and excision groups in brain abscess patients
aspiration (%) Excision (%) p-value
No of Pts 9 8 17
Sex
 M 6 (66.7) 6 (75.0) 12 1.000
 F 3 (33.3) 2 (25.0) 5
Age
 <65 5 (55.6) 5 (62.5) 10 1.000
 ≥65 4 (44.4) 3 (37.5) 7
Comorbidities 5 (55.6) 6 (75.0) 11 1.000
 Headache 8 (88.9) 4 (50.0) 12 0.131
 Fever 2 (22.2) 2 (25.0) 4 1.000
 Confusion 3 (33.3) 2 (25.0) 5 1.000
 Hemiplegia 3 (33.3) 3 (37.5) 6 1.000
 Nausea and Vomiting 3 (33.3) 0 3 0.206
 Seizure 2 (22.2) 0 2 0.471
 Dysarthria 1 (11.1) 3 (37.5) 4 0.294
White blood cell count 1.000
 <10.8×103 /uL 4 (44.4) 3 (37.5) 7
 ≥10.8×103 /uL 5 (55.6) 5 (62.5) 10
Number of abscess 0.576
 solitary 8 (88.9) 6 (75.0) 14
 multiple 1 (11.1) 2 (25.0) 3
Location of abscess 0.101
 Frontal lobe 2 (22.2) 4 (50.0) 6
 Temporal lobe 4 (44.4) 0 4
 Parietal lobe 2 (22.2) 2 (25.0) 4
 Occipital lobe 1 (11.1) 0 1
 Basal ganglia 0 2 (25.0) 2
 Brain stem 0 0
Volume of abscess 0.050
 <1cm3 1 (11.1) 0 1
 1-10 cm3 4 (44.4) 0 4
 >10cm3 4 (44.4) 8 (100.0) 12
Outcome 0.335
 Good (mRS≤2) 7 (77.8) 4 (50.0) 11
 Poor (mRS>2) 2 (22.2) 4 (50.0) 6
Duration of hospitalization (days) 53.4 51.8 0.464

M: Male, F: Female.

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