Polyzoidis K S, Vranos G, Exarchakos G, Argyropoulou M I, Korantzopoulos P, Skevas A
Department of Neurosurgery, University of Ioannina, Medical School, Ioannina, Greece.
Int J Clin Pract. 2004 Feb;58(2):214-7. doi: 10.1111/j.1368-5031.2004.0050.x.
The infratentorial variety of the subdural empyema, with or without coexisting cerebellar abscess, is a rare clinical entity that carries a high mortality rate. We briefly describe the case of a 49-year-old man presented with severe debility, fever and an obviously neglected chronic otitis media. The patient had refused surgical treatment several months ago. After admission, his level of consciousness began to deteriorate, and the radiological studies showed infratentorial subdural suppuration extending into the right cerebellar hemisphere, along with chronic pyogenic infection of the middle ear and the mastoid process. Radical mastoidectomy was performed first, followed by extensive right posterior fossa craniectomy. The two subdural collections and the cerebellar abscess were successfully evacuated. Subsequently, he received post-operative antibiotic treatment for 6 weeks. At follow-up, 10 months after surgery, his neurological recovery was complete except for a minor residual cerebellar dysfunction on the right. This unusual case highlights that in patients presented with severe intracranial complications of chronic otitis media, early diagnosis and radical surgical intervention may be life saving.
硬膜下积脓的幕下型，无论是否并存小脑脓肿，都是一种罕见的临床病症，死亡率很高。我们简要描述一例49岁男性病例，该患者表现为严重虚弱、发热，并有明显被忽视的慢性中耳炎。该患者数月前拒绝了手术治疗。入院后，他的意识水平开始恶化，影像学检查显示幕下硬膜下化脓蔓延至右侧小脑半球，同时伴有中耳和乳突的慢性化脓性感染。首先进行了根治性乳突切除术，随后进行了广泛的右后颅窝颅骨切除术。成功清除了两个硬膜下积脓灶和小脑脓肿。随后，他接受了为期6周的术后抗生素治疗。术后10个月随访时，除右侧有轻微残留小脑功能障碍外，他的神经功能已完全恢复。这个不寻常的病例突出表明，对于出现慢性中耳炎严重颅内并发症的患者，早期诊断和根治性手术干预可能挽救生命。
