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脊髓硬膜外脓肿:当前的诊断与治疗。

Spinal epidural abscess: current diagnosis and management.

机构信息

Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer Building, Room 8-161, Baltimore, MD, 21287, USA,

出版信息

Curr Infect Dis Rep. 2010 Nov;12(6):484-91. doi: 10.1007/s11908-010-0140-1.

Abstract

Spinal epidural abscess (SEA) is an uncommon condition that warrants urgent diagnosis and treatment, because early pharmacotherapy significantly improves prognosis and prompt surgical decompression is often necessary to prevent or minimize neurologic complications. Increased awareness is critical; any of the characteristic clinical findings, especially in the presence of risk factors and elevated inflammatory markers, should lead to heightened suspicion for SEAs and its consideration on differential diagnosis, even in the absence of neurologic deficits. A multidisciplinary approach is essential for successful management of SEAs; along with infectious disease specialists and neurosurgeons/orthopedic spine surgeons, primary care, emergency medicine, and internal medicine clinicians are more likely to see patients with SEAs at earlier stages and play a pivotal role in early diagnosis and treatment. A combination of targeted antibiotic therapy and prompt surgical decompression is recommended in most cases, although medical management alone can be effective in select patients under close monitoring.

摘要

脊髓硬膜外脓肿(SEA)是一种不常见的疾病,需要紧急诊断和治疗,因为早期药物治疗可以显著改善预后,并且通常需要及时手术减压以预防或最小化神经并发症。提高认识至关重要;任何特征性的临床发现,尤其是在存在危险因素和炎症标志物升高的情况下,都应高度怀疑 SEA,并将其纳入鉴别诊断,即使没有神经功能缺损。多学科方法是成功治疗 SEA 的关键;除了传染病专家和神经外科医生/骨科脊柱外科医生外,初级保健、急诊医学和内科医生更有可能在早期阶段看到 SEA 患者,并在早期诊断和治疗中发挥关键作用。大多数情况下,建议采用靶向抗生素治疗和及时手术减压相结合,但在密切监测下,某些特定患者单独采用药物治疗也可能有效。

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