Pompucci Angelo, De Bonis Pasquale, Sabatino Giovanni, Federico Giovanni, Moschini Massimo, Anile Carmelo, Mangiola Annunziato
Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
J Neuroimaging. 2007 Oct;17(4):358-60. doi: 10.1111/j.1552-6569.2007.00084.x.
Subdural empyema represents a loculated infection between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. While treatment guidelines for a single (either brain or spinal) localization of a subdural empyema are more or less established, its management when a massive involvement of CNS is evident represents a challenge.
The authors describe a unique case of a 65-year-old woman having a massive involvement of the entire CNS with multiple localizations, both intracranial and spinal. Early diagnosis was obtained through brain CT scans followed by cranio-spinal contrast enhanced MRI scans. Patient was treated with external ventricular drainage and suboccipital craniectomy, while on antibiotic therapy.
Patient's neurological condition gradually improved. By the end of the eighth hospital week, she was discharged without any neurological deficit.
Spinal subdural empyema and brain subdural empyema are not always, as in our case, two different entities. Prompt diagnosis and treatment constitute the major variables affecting outcome.
硬脑膜下积脓是指硬脑膜与蛛网膜之间的局限性感染。颅内或椎管内均有相关报道，后者较为罕见。虽然针对单一部位（脑部或脊髓）硬脑膜下积脓的治疗指南已基本确立，但当明显累及整个中枢神经系统（CNS）时，其治疗仍具挑战性。
作者描述了一例独特病例，一名65岁女性整个中枢神经系统广泛受累，存在多个部位的病变，包括颅内和脊髓。通过脑部CT扫描，随后进行颅脊髓对比增强MRI扫描得以早期诊断。患者在接受抗生素治疗的同时，接受了脑室外引流和枕下颅骨切除术。
患者的神经状况逐渐改善。到第八个住院周结束时，她出院时没有任何神经功能缺损。
脊髓硬脑膜下积脓和脑硬脑膜下积脓并非总是像我们的病例那样是两种不同的情况。及时诊断和治疗是影响预后的主要因素。
