van de Beek Diederik, Campeau Norbert G, Wijdicks Eelco F M
Division of Critical Care Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Neurology. 2007 Jul 31;69(5):477-81. doi: 10.1212/01.wnl.0000266631.19745.32.
Infratentorial empyema is an uncommon complication of bacterial meningitis. Very little is known about its recognition and appropriate management.
We present a patient with infratentorial subdural empyema and compare findings with 41 cases with infratentorial empyema reported in the literature.
Many patients with infratentorial empyema presented as subacute meningitis with neck stiffness and decreased consciousness. Diagnosis was often delayed. The minority had cerebellar findings and cranial nerve deficits. Clues to the diagnosis were presence of otitis, sinusitis, or mastoiditis and recent surgery for these disorders. The majority of patients underwent craniotomy; conservative treatment with antibiotics was associated with relapse of symptoms. The mortality rate was high especially in those with subdural empyema. CT failed to clearly visualize infratentorial subdural empyema in several reported cases.
Infratentorial empyema is a life-threatening rare complication of bacterial meningitis. MRI, including diffusion-weighted imaging, is the preferred imaging technique in patients with suspected or proven bacterial meningitis and associated ear-nose-throat infection with deterioration in consciousness and neurologic signs that suggest a posterior fossa lesion. Neurosurgery should be regarded as first choice therapy.
幕下积脓是细菌性脑膜炎一种少见的并发症。对其识别和恰当处理了解甚少。
我们报告一例幕下硬膜下积脓患者，并将其表现与文献报道的41例幕下积脓病例进行比较。
许多幕下积脓患者表现为亚急性脑膜炎，伴有颈部强直和意识减退。诊断常常延迟。少数患者有小脑体征和颅神经缺损。诊断线索为存在中耳炎、鼻窦炎或乳突炎以及近期针对这些疾病的手术史。大多数患者接受了开颅手术；抗生素保守治疗与症状复发相关。死亡率很高，尤其是硬膜下积脓患者。在一些报道的病例中，CT未能清晰显示幕下硬膜下积脓。
幕下积脓是细菌性脑膜炎一种危及生命的罕见并发症。对于疑似或确诊细菌性脑膜炎且伴有耳鼻喉感染、意识恶化及提示后颅窝病变的神经体征的患者，包括弥散加权成像在内的MRI是首选的影像学检查技术。神经外科手术应被视为首选治疗方法。
