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一名幼儿因肺炎链球菌感染导致脊髓硬膜外脓肿合并脊髓炎和脑膜炎。

Spinal epidural abscess with myelitis and meningitis caused by Streptococcus pneumoniae in a young child.

作者信息

Bhattacharya Malobika, Joshi Neha

机构信息

Maulana Azad Medical College, Delhi, India.

出版信息

J Spinal Cord Med. 2011;34(3):340-3. doi: 10.1179/107902610x12883422813507.

DOI:10.1179/107902610x12883422813507
PMID:21756576
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3127372/
Abstract

BACKGROUND

Spinal epidural abscess (SEA) in children is a rare infectious emergency warranting prompt intervention. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Staphylococcus aureus is the most common isolate.

DESIGN

Case report and literature review.

FINDINGS

A 2.5-year-old boy with tetraparesis was found to have an SEA in the posterior lumbar epidural space with evidence of meningitis and myelitis on MRI spine in the absence of any local or systemic predisposing factors or spinal procedures. Streptococcus pneumoniae was isolated from the evacuated pus.

CONCLUSIONS

Definitive treatment of SEA is a combination of surgical decompression and iv antibiotics. Timely management limits the extent of neurological deficit.

摘要

背景

儿童脊髓硬膜外脓肿（SEA）是一种罕见的感染性急症，需要及时干预。诱发因素包括免疫抑制、脊柱手术以及局部感染，如椎体骨髓炎和椎旁脓肿。金黄色葡萄球菌是最常见的分离菌株。

设计

病例报告及文献综述。

结果

一名2.5岁的四肢瘫痪男孩被发现后腰椎硬膜外间隙存在脊髓硬膜外脓肿，脊柱磁共振成像显示有脑膜炎和脊髓炎迹象，且不存在任何局部或全身诱发因素或脊柱手术史。从抽出的脓液中分离出肺炎链球菌。

结论

脊髓硬膜外脓肿的确定性治疗是手术减压与静脉注射抗生素相结合。及时处理可限制神经功能缺损的程度。

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本文引用的文献

1
Holocord spinal epidural abscess.全脊髓硬脊膜外脓肿
J Child Neurol. 2009 Jun;24(6):768-71. doi: 10.1177/0883073808329524.
2
Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty.与椎板成形术相比，接受椎板切除术的儿童髓内脊髓肿瘤切除术后脊柱畸形的发生率。
J Neurosurg Pediatr. 2008 Jan;1(1):57-62. doi: 10.3171/PED-08/01/057.
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Spinal epidural abscess in clinical practice.临床实践中的脊柱硬膜外脓肿
QJM. 2008 Jan;101(1):1-12. doi: 10.1093/qjmed/hcm100. Epub 2007 Nov 3.
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Spinal epidural abscess.脊柱硬膜外脓肿
N Engl J Med. 2006 Nov 9;355(19):2012-20. doi: 10.1056/NEJMra055111.
5
Spinal epidural abscess: appearance on magnetic resonance imaging as a guide to surgical management. Report of five cases.脊柱硬膜外脓肿：磁共振成像表现对手术治疗的指导作用。五例报告。
Neurosurg Focus. 2004 Dec 15;17(6):E12. doi: 10.3171/foc.2004.17.6.12.
6
Multiple spinal epidural abscesses extending to the whole spinal canal.多个脊髓硬膜外脓肿蔓延至整个椎管。
Magn Reson Imaging. 2004 Jun;22(5):747-50. doi: 10.1016/j.mri.2004.01.072.
7
The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.诊断延迟对急诊科脊髓硬膜外脓肿患者的临床表现及影响。
J Emerg Med. 2004 Apr;26(3):285-91. doi: 10.1016/j.jemermed.2003.11.013.
8
Macrolide-resistant pneumococcal endocarditis and epidural abscess that develop during erythromycin therapy.在红霉素治疗期间发生的耐大环内酯类肺炎球菌性心内膜炎和硬膜外脓肿。
Clin Infect Dis. 2003 Jan 15;36(2):e19-25. doi: 10.1086/344965. Epub 2003 Jan 7.
9
Epidural abscess complicating insertion of epidural catheters.硬膜外脓肿并发硬膜外导管置入术。
Br J Anaesth. 2002 Nov;89(5):778-82.
10
Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes.脊柱硬膜外脓肿：临床表现、预后因素及结局
Neurosurgery. 2002 Jul;51(1):79-85; discussion 86-7. doi: 10.1097/00006123-200207000-00013.