====== Multiple brain abscess ======

Seeding of the brain presumably occurs via transit of infecting [[bacteria]] through the valveless [[emissary vein]]s that drain regions of [[paranasal sinus]]es, [[middle ear]], [[teeth]], etc., and permit direct or retrograde flow into the venous drainage systems of the brain. Other causes are penetrating injury, metastatic seeding of the brain from distant extracranial sources...
((Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. 1997 Oct;25(4):763-79; quiz 780-1. doi: 10.1086/515541. PMID: 9356788.))
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The case notes of 14 consecutive patients with multiple [[brain abscess]]es presenting over a 14 year period were studied with respect to the [[incidence]] and [[presentation,]] the source of [[infection]], the [[investigation]]s, [[microbiology]] and the [[treatment]] and [[outcome]]. The incidence of multiple brain abscesses in non-immunocompromised patients is 13% of all [[intracranial abscess]]es. Computerized tomographic scanning is vital both in the detection of multiple abscesses and in the subsequent assessment of therapy. The source of infection in half of our patients was the teeth or the [[paranasal sinus]]es. [[Streptococcus]] were isolated in 63% of the patients; [[staphylococcus]] in 21%. This has obvious implications for the [[antibiotic]] policy. [[Intracranial]] surgery, with few exceptions, had a diagnostic and management role rather than a curative one; identification of the causative organism was its prime purpose. [[CSF]], obtained by lumbar punctures, did not provide any positive cultures and should not be contemplated in view of the inherent hazards. The elimination of the primary focus of infection was a most important step in the management of this condition. Multiple brain abscesses represent a potentially curable condition, provided appropriate antibiotics are used, the primary septic focus is eliminated and the intracranial [[complication]]s are anticipated by the use of frequently repeated CT scans
((Kratimenos G, Crockard HA. Multiple brain abscess: a review of fourteen cases. Br J Neurosurg. 1991;5(2):153-61. doi: 10.3109/02688699108998461. PMID: 1863376.)).