Deininger Martin H, Berlis Ansgar, Buttler Juergen
Department of General Neurosurgery, University of Freiburg Medical School, Breisacher Str. 64, Freiburg 79106, Germany.
Neurocrit Care. 2007;7(1):27-30. doi: 10.1007/s12028-007-0013-0.
In bacterial shunt infection, CNS inflammation is a frequently observed complication that may cause vascular complications including vasospasms. Here, we describe the first patient with shunt infection-induced cerebral vasospasms.
A 35 year old woman with a ventriculoperitoneal shunt that was implanted years before developed facial nerve palsy and somnolence one week before admission to the hospital.
After admission, the shunt was removed, and an external ventricular drainage was inserted. Microbiological analyses revealed coagulase-negative Staphylococcus on abdominal and cranial catheters. Follow-up NMR showed infarctions. Transcranial doppler sonography and cerebral arteriography revealed severe generalized cerebral vasospasms. Inspite of triple-H therapy and intraarterial spasmolysis, bilateral anterior and media artery infarction evolved. The patient was dismissed in a vegetative state.
This case shows that severe cerebral vasospasms are a serious complication in patients with bacterial shunt infection that should be considered in patients, that don't improve following adequate antibiotic treatment.
在细菌性分流感染中，中枢神经系统炎症是一种常见并发症，可能导致包括血管痉挛在内的血管并发症。在此，我们描述首例因分流感染引起脑血管痉挛的患者。
一名35岁女性，多年前植入了脑室腹腔分流管，入院前一周出现面神经麻痹和嗜睡症状。
入院后，移除分流管并插入外部脑室引流管。微生物学分析显示，腹部和脑部导管上存在凝固酶阴性葡萄球菌。后续核磁共振成像显示有梗死灶。经颅多普勒超声和脑血管造影显示严重的全身性脑血管痉挛。尽管采用了“三高”疗法和动脉内解痉治疗，但双侧前动脉和中动脉梗死仍有进展。患者出院时处于植物人状态。
该病例表明，严重脑血管痉挛是细菌性分流感染患者的严重并发症，对于接受充分抗生素治疗后病情无改善的患者应考虑这一情况。
