Cranial intradural abscess management of 641 patients during the 35 years from 1952 to 1986.

The changes in management of intradural brain abscess at Groote Schuur Hospital for the 35 years 1952-1986 are reviewed. An improvement in mortality was found from 45% for 1952-1965 (period A), to 27% for 1966-1976 (period B); and lastly to 17% for 1977-1986 (period C). The improvement in the results was associated with the use of computed axial tomography (CT) and metronidazole. Abscesses secondary to ear infection were the commonest while those following trauma represented the second most frequent etiological group. Among the 26 cases of pulmonary origin in period C, 12 had pulmonary tuberculosis. Comparison of the outcome for patients presenting with Glasgow coma scale (GCS) 15 showed 39% mortality for period A compared with 3.5% in period C. Those patients who were comatose with GCS 8-3 had mortalities of 70 and 59% in periods A and C, respectively, indicating the importance of early diagnosis which has been facilitated by the advent of CT.