Steroids for brain abscess
Steroids for Brain Abscess is controversial.
Reduces edema, but may reduce antibiotic penetration into abscess 1).
It seems to only partially inhibit adequate concentrations of antibiotics in brain tissue dependent upon the antibiotics used 2).
Immune supression may also be deleterious.
There is no well-controlled, randomized clinical study evaluating the use of corticosteroids for controlling the cerebral edema surrounding BA; nevertheless, corticosteroids are recommended perioperatively for reducing intracranial pressure and avoiding acute brain herniation 3) but only in those patients that demonstrate signs of meningitis or disproportionate cytotoxic edema posing a life-threatening problem 4).
Steroids can retard the encapsulation process, increase necrosis, reduce antibiotic penetration into the abscess, increase the risk of ventricular rupture, and alter the appearance on CT scans because of contrast reduction. Steroid therapy can also produce a rebound effect when discontinued. Corticosteroids are used when a significant mass effect is visible on imaging and the patient’s mental status is depressed. When used to reduce cerebral edema, therapy should be of short duration. The appropriate dosage, the proper timing, and any effect of steroid therapy on the course of the disease are unknown 5).
Reduces edema, but may reduce antibiotic penetration into abscess 1).
It seems to only partially inhibit adequate concentrations of antibiotics in brain tissue dependent upon the antibiotics used 2).
Immune supression may also be deleterious.
There is no well-controlled, randomized clinical study evaluating the use of corticosteroids for controlling the cerebral edema surrounding BA; nevertheless, corticosteroids are recommended perioperatively for reducing intracranial pressure and avoiding acute brain herniation 3) but only in those patients that demonstrate signs of meningitis or disproportionate cytotoxic edema posing a life-threatening problem 4).
Steroids can retard the encapsulation process, increase necrosis, reduce antibiotic penetration into the abscess, increase the risk of ventricular rupture, and alter the appearance on CT scans because of contrast reduction. Steroid therapy can also produce a rebound effect when discontinued. Corticosteroids are used when a significant mass effect is visible on imaging and the patient’s mental status is depressed. When used to reduce cerebral edema, therapy should be of short duration. The appropriate dosage, the proper timing, and any effect of steroid therapy on the course of the disease are unknown 5).
Case reports
A case of acute brain abscess in a 59-year-old man is presented. The primary CT findings were misinterpreted as a brain infarct or possibly a tumour. Under steroid therapy an activation of the brain abscess was observed in only nine days and in spite of an immediate operation the patient died 6).
1)
Rosenblum ML, Hoff JT, Norman D, Edwards MS, Berg BO. Nonoperative treatment of brain abscesses in selected high-risk patients. J Neurosurg. 1980 Feb;52(2):217-25. PubMed PMID: 7351561.
2)
Kourtópoulos H, Holm SE, Norrby SR. The influence of steroids on the penetration of antibiotics into brain tissue and brain abscesses. An experimental study in rats. J Antimicrob Chemother. 1983 Mar;11(3):245-9. PubMed PMID: 6841306.
3)
Lee TH, Chang WN, Su TM, Chang HW, Lui CC, Ho JT, Wang HC, Lu CH. Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses. J Neurol Neurosurg Psychiatry. 2007 Mar;78(3):303-9. Epub 2006 Sep 29. PubMed PMID: 17012340; PubMed Central PMCID: PMC2117635.
4)
Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011;9(2):136-44. doi: 10.1016/j.ijsu.2010.11.005. Epub 2010 Nov 16. Review. PubMed PMID: 21087684.
6)
Strohecker J, Kollmann H, Piotrowski W, Grobovschek M. Exacerbation of brain abscess during exclusive treatment with steroids, demonstrated by computerised tomography. Neurochirurgia (Stuttg). 1985 Jan;28(1):20-1. PubMed PMID: 3974790.