Higuchi Kanako, Ishihara Hiroyuki, Okuda Shiho, Kanda Fumio
Department of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
BMJ Case Rep. 2011 May 10;2011:bcr1120103512. doi: 10.1136/bcr.11.2010.3512.
The authors report a case of a 51-year-old man with intramedullary spinal cord abscess (ISCA) having a patent foramen ovale (PFO). He developed fever and tetraplegia after a recent dental treatment. MRI showed ISCA with longitudinal swelling from the upper cervical to the lumbar spinal cord. Cerebrospinal fluid (CSF) analysis indicated bacterial meningitis, and the culture of CSF revealed Streptococcus viridans. Transoesophageal echocardiography revealed the existence of a PFO. We suspected another possibility other than systemic bacteraemia, that paradoxical bacteric embolisation through PFO after the dental treatment caused ISCA. While several reports of brain abscess with PFO are available, this is the first report of ISCA with PFO.
作者报告了一例51岁男性患有脊髓内脓肿（ISCA）且伴有卵圆孔未闭（PFO）的病例。他在近期接受牙科治疗后出现发热和四肢瘫痪。磁共振成像（MRI）显示ISCA，脊髓从颈上段至腰段呈纵向肿胀。脑脊液（CSF）分析提示细菌性脑膜炎，CSF培养显示为草绿色链球菌。经食管超声心动图显示存在卵圆孔未闭。我们怀疑除全身菌血症外的另一种可能性，即牙科治疗后通过卵圆孔未闭的反常细菌栓塞导致了脊髓内脓肿。虽然有几篇关于伴有卵圆孔未闭的脑脓肿的报道，但这是首例伴有卵圆孔未闭的脊髓内脓肿的报道。
