Brain Stem Abscesses: Cure with Medical Therapy, Case Report, and Review

A patient with a brain stem abscess that was cured with medical therapy alone is described. The English-language literature on brain stem abscesses is reviewed. Computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the rapidity with which the diagno-sis can be made and have markedly changed the prognosis for patients with brain stem abscesses. To my knowledge, all patients whose brain stem abscesses have been diagnosed by MRI or CT have survived although some have had neurological residuals. Patients are usually treated with surgical excision or aspiration along with antibiotics. Our patient was treated with medical ther-apy alone, and this case represents the fourth reported cure with this treatment modality. Medi-cal therapy may be anticipated to cure patients with brain stem abscesses whose conditions are diagnosed expeditiously with CT or MRI techniques. A patient with a brain stem abscess was recently cared for at our institution. Because of its location in the medulla, neither excisional surgery nor aspiration of the abscess was possible. It is fortunate that the patient recovered with medi-cal therapy alone. The case is reported, and the English-lan-guage literature on the clinical manifestations and on ther-apy for brain stem abscesses is reviewed. On the basis of the published data and our experience, an approach to this un-common but potentially catastrophic problem is presented