Kawano Hiroyuki, Yonemura Kiminobu, Misumi Youhei, Hashimoto Yoichiro, Hirano Teruyuki, Uchino Makoto
Department of Neurology, Kumamoto City Hospital.
Rinsho Shinkeigaku. 2005 Jun;45(6):449-52.
The patient was a 29-year-old man with sinusitis. He was admitted with high grade fever, headache, vomiting and disturbance of consciousness. Neurological examination revealed nuchal rigidity, aphasia, right hemiparesis, right sensory disturbance and bilateral Babinski signs. A nonenhanced CT on admission showed a low density area in the interhemispheric fissure. Gadolinium-enhanced MRI and DWI showed an interhemispheric subdural empyema and sinusitis. Neurological deficits gradually improved, after he underwent urgent surgical drainage of sinusitis followed by antibiotics therapy. About three weeks later, he developed right hemiparesis and disturbance of consciousness, and MRI demonstrated the expansion of interhemispheric subdural empyema. Therefore, he underwent surgical drainage of interhemispheric subdural empyema. He was discharged from our hospital without neurologic deficit. We suggest that MRI, in particular DWI, is a useful additional imaging modality for the diagnosis of interhemispheric subdural empyema.
该患者为一名29岁患有鼻窦炎的男性。他因高热、头痛、呕吐及意识障碍入院。神经系统检查发现颈项强直、失语、右侧偏瘫、右侧感觉障碍及双侧巴宾斯基征。入院时的非增强CT显示大脑镰裂内有低密度区。钆增强MRI及弥散加权成像（DWI）显示大脑镰下硬膜下积脓及鼻窦炎。在他接受鼻窦炎紧急手术引流并随后接受抗生素治疗后，神经功能缺损逐渐改善。大约三周后，他出现右侧偏瘫及意识障碍，MRI显示大脑镰下硬膜下积脓扩大。因此，他接受了大脑镰下硬膜下积脓的手术引流。他出院时无神经功能缺损。我们认为MRI，尤其是DWI，是诊断大脑镰下硬膜下积脓的一种有用的补充影像学检查方法。
