In Stage I, most of the patients present with clinical features of meningitis. Stage III, however presents with localizing sign, e.g. , hemiparesis or features of herniation. Surgical intervention can be either by repeated tappings or excision. It is, therefore, very essential to diagnose an abscess at an early stage of its evolution, as it avoids surgical intervention. Steroids reduce brain edema but diminish the effectiveness of the host defense mechanisms that assist in containment of infection.
Steroids inhibit collagen capsule formation and also inhibit migration of leucocytes.
There can be various modes of surgical management. In our series, drainage was successfully done without making any burr hole in the skull. A 2-3 mm drill is as effective as a burr hole in draining the pus. This can even be done under local anesthesia at the bedside. In conclusion, brain abscess following CSOM can be effectively managed if the evolution pattern is known, as the treatment is now mainly based on the stage of abscess formation.