Steroids for brain abscess
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).
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).