Nica D A, Moroti-Constantinescu R, Copaciu R, Nica M
Neurosurgery Clinic, "Sf. Pantelimon" Clinical Emergency Hospital, Bucharest, Romania.
Chirurgia (Bucur). 2011 Sep-Oct;106(5):673-6.
Cranial subdural empyema (SDE), a localized septic intracranial collection, occurs mostly as a complication of sinusitis, otitis or mastoiditis. Although relatively rare, SDE requires an increased attention for early recognition, cerebral imagery being mandatory in any suspected case. Any delay in treatment can lead to coma with a fatal outcome. The authors report the case of a young boy, who developed a severe, important cerebral edema, thin subdural collection with minimal displacement of the median line. Repeated cerebral MRI showed an enlarged subdural collection with higher median line shift and imposed rapid surgical intervention. The collection proved to be empyema. Other findings on MRI are pansinusitis, mild mastoiditis and transverse sinus thromboflebitis. The recovery was accompanied by the need for long course of antibiotherapy, secondary epilepsy treatment and kinetotherapy for hemiparesis. The patient also developed intracerebral cysts expanding the brain through the postoperative cranial defect which later needed surgical intervention, for both neurological and esthetic improvement. The management of the case implied strong interdisciplinary collaboration between infectionist, neurologist, neurosurgeon, microbiologist and imagist.
颅骨硬膜下积脓（SDE）是一种局限性颅内化脓性病变，主要作为鼻窦炎、中耳炎或乳突炎的并发症出现。虽然相对罕见，但SDE需要更多关注以便早期识别，对于任何疑似病例，脑部影像学检查必不可少。治疗的任何延误都可能导致昏迷并带来致命后果。作者报告了一名小男孩的病例，他出现了严重的、明显的脑水肿，硬膜下积液较薄，中线移位轻微。反复的脑部磁共振成像（MRI）显示硬膜下积液增大，中线移位更明显，因此需要迅速进行手术干预。积液被证实为积脓。MRI上的其他发现包括全鼻窦炎、轻度乳突炎和横窦血栓性静脉炎。康复过程中需要长期的抗生素治疗、继发性癫痫治疗以及针对偏瘫的运动疗法。患者还出现了脑内囊肿，通过术后颅骨缺损使脑部扩大，后来为了神经功能和美观改善需要进行手术干预。该病例的管理需要感染病专家、神经科医生、神经外科医生、微生物学家和影像学专家之间强有力的跨学科协作。
