Kim Jong Hun, Lee Chul-Hee, Hwang Soo Hyun, Kang Dong Ho
Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea.
J Korean Neurosurg Soc. 2009 Jan;45(1):53-6. doi: 10.3340/jkns.2009.45.1.53. Epub 2009 Jan 31.
The authors present a case of subdural empyema in a macrocephalic patient. A 23-year-old male was admitted due to headache and fever. One month ago, he had mild head injury by his coworkers. Physical examination showed a macrocephaly and laboratory findings suggested purulent meningitis. Neuroimaging studies revealed a huge size of epidural space-occupying lesion. Under the impression of epidural abscess, operation was performed. Eventually, the lesion was located at subdural space and was proven to be subdural empyema. Later, histological examination of the specimen obtained by surgery demonstrated finings consistent with the capsule of the chronic subdural hematoma. Two weeks after operation, Propionibacterium acnes was isolated. The intravenous antibiotics were used for total of eight weeks under monitoring of the serum level of the C-reactive protein. Follow-up brain computed tomography (CT) scan showed the presence of significant amount of remaining subdural lesion. However, he has complained of minimal discomfort. It is suggested that the subdural empyema occurred with preexisting chronic subdural hematoma after head injury about one month prior to admission and it took a long time to treat Propionibacterium acnes subdural empyema with systemic antibiotics, at least over eight weeks.
作者报告了一例巨头症患者的硬脑膜下积脓病例。一名23岁男性因头痛和发热入院。一个月前,他被同事轻度头部外伤。体格检查发现巨头症,实验室检查结果提示化脓性脑膜炎。神经影像学研究显示硬膜外有巨大占位性病变。在硬膜外脓肿的诊断下进行了手术。最终,病变位于硬膜下间隙,经证实为硬脑膜下积脓。后来,手术获取标本的组织学检查结果显示与慢性硬膜下血肿包膜一致。术后两周,分离出痤疮丙酸杆菌。在监测C反应蛋白血清水平的情况下,静脉使用抗生素共八周。随访脑部计算机断层扫描(CT)显示仍有大量硬膜下病变残留。然而,他仅主诉有轻微不适。提示硬脑膜下积脓发生于入院前约一个月头部受伤后已存在的慢性硬膜下血肿基础上,且用全身性抗生素治疗痤疮丙酸杆菌性硬脑膜下积脓需要很长时间,至少超过八周。