Banerjee Anirban Deep, Pandey Paritosh, Ambekar Sudheer, Chandramouli B A
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
Childs Nerv Syst. 2010 Aug;26(8):1117-20. doi: 10.1007/s00381-010-1157-3. Epub 2010 May 2.
Intracranial subdural tubercular empyema is an extremely rare entity. To our knowledge, only one such case has been previously reported in the pediatric population (Cayli et al. J Neurosurg 94(6):988-991, 2001). We report a case of intracranial tubercular subdural empyema in a child, with both convexity and interhemispheric fissure involvement.
A 12-year-old boy with history of exposure to an active case of pulmonary tuberculosis (his father) presented to our institution with features of raised intracranial pressure and fever for 1 month and altered sensorium for 2 days. Computerized tomography (contrast enhanced) revealed a left fronto-parietal and interhemispheric subdural space abscess. A left fronto-parietal craniotomy was performed and the subdural empyema was evacuated, and adjacent calvarium was normal. Ziehl-Neelsen staining revealed acid-fast bacilli and the subsequent polymerase chain reaction test was positive. Histopathological examination showed granulation tissue including scattered multinucleated giant cells and caseation. Mycobacterium tuberculosis bacilli were the sole organisms cultured after 6 weeks. Anti-tuberculous treatment was given in appropriate doses for 18 months at the end of which the patient was doing well with no deficits.
Intracranial tubercular subdural empyema in the pediatric age group is an extremely rare but curable entity.
颅内硬膜下结核性脓肿是一种极其罕见的病症。据我们所知，此前仅在儿科人群中报道过一例此类病例（Cayli等人，《神经外科杂志》94(6):988 - 991，2001年）。我们报告一例儿童颅内结核性硬膜下脓肿病例，累及脑凸面和大脑半球间裂。
一名12岁男孩，有接触活动性肺结核病例（其父亲）的病史，因颅内压升高和发热1个月、意识改变2天前来我院就诊。计算机断层扫描（增强造影）显示左侧额顶叶及大脑半球间硬膜下间隙脓肿。行左侧额顶叶开颅手术，清除硬膜下脓肿，相邻颅骨正常。齐-尼氏染色显示抗酸杆菌，随后的聚合酶链反应检测呈阳性。组织病理学检查显示肉芽组织，包括散在的多核巨细胞和干酪样坏死。6周后培养出的唯一微生物是结核分枝杆菌。给予适当剂量的抗结核治疗18个月，治疗结束时患者情况良好，无神经功能缺损。
儿童颅内结核性硬膜下脓肿是一种极其罕见但可治愈的病症。
