Original communication| Volume 13, ISSUE 2, P309-315, February 1943

Metastatic brain abscess

Complicating inconspicuous pulmonary suppuration in the presence of chronic nontuberculous empyema
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      • 1.
        1. During the years 1934 to 1941, inclusive, 343 cases of empyema have been admitted to the University of Michigan Hospital. Of this group, 132 cases were considered chronic. Six of these patients with chronic empyema died of metastatic cerebral abscess, an incidence of 4.5 per cent.
      • 2.
        2. The six cases with their autopsy findings are reported in detail. In four of the cases the previous empyema space was obliterated. Five of the six cases displayed varying degrees of chronic parenchymal pulmonary suppuration. This was considered a more probable source of emboli than the pleural infection.
      • 3.
        3. Adequate and dependent drainage of the empyema was established in four of the six cases after admission to the hospital. No definite correlation was noted between manipulation at the empyema drainage site and the onset of cerebral symptoms.
      • 4.
        4. In four of the reported cases the cerebral abscess was solitary; in one, multiple, and in one, multilocular. In none of the cases has encapsulation of the abscess been present. All had a purulent meningitis and in two cases rupture of the abscess into the adjacent lateral ventricle occurred.
      • 5.
        5. In three cases of brain abscess exploratory craniotomy was done; in two of the cases the abscess was drained surgically, while in one the abscess was evacuated through the exploring needle. Appropriate chemotherapy with one of the sulfonamide compounds was carried out in these three cases.
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