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Burr-Hole Aspiration For Abscess :

Burr Hole Aspiration Abscess Procedures, India Burr Hole Aspiration Abscess

Three cases of brain abscess caused by Actinomyces israelii are reported which were successfully treated by burr hole aspiration and a short course of antibiotics (3-4 weeks). The clinical response of the patients, as well as the serial serum C-reactive protein levels and CT findings were used as a guideline for stopping antimicrobial therapy relatively early.

Material And Methods

The patients underwent surgery at two different institutions. Computed tomography scanning and magnetic resonance imaging were performed, along with diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy. The abscesses were drained via a transmastoid route.


Onset may be sudden or subacute over several weeks :

  • Common presenting symptoms include fever, headache, changes in mental state (drowsiness, confusion), focal neurological deficits, grand-mal seizures, nausea and vomiting, neck stiffness.
  • A suddenly worsening headache, followed by emerging signs of meningism is often associated with rupture of the abscess.


  • Fever
  • Focal motor or sensory deficits
  • Raised blood pressure and bradycardia associated with raised intracranial pressure
  • Papilloedema
  • Ataxia
  • Confusion, drowsiness
  • Bulging fontanelle in infants


  • Intracerebral abscesses may rupture into the ventricular system and produce ventriculitis.
  • Epilepsy occurs in around 30%, particularly with temporal lobe abscess and subdural empyema. Anticonvulsants may be required.
  • Mainly depending on the speed of diagnosis and treatment, 20-80% of survivors have neurological sequelae, e.g. hemiparesis, visual field loss.

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