Shimohata Mitsuteru, Naruse Satoshi, Kawasaki Satoshi, Watanabe Yumiko, Koyama Miyako, Ito Yasushi, Tanaka Hajime
Department of Neurology, Shinrakuen Hospital.
Rinsho Shinkeigaku. 2012;52(6):429-32. doi: 10.5692/clinicalneurol.52.429.
Here, we report brain abscess due to Fusobacterium necrophorum (F. necrophorum) in a 78-year-old healthy man. He developed convulsion and did not have any signs of meningitis. Although the brain magnetic resonance imaging findings of the left occipital lobe were typical of a brain abscess, his cerebrospinal fluid examination revealed only slight pleocytosis and mild increase in protein levels. Thus, it was difficult to rule out the possibility of metastatic brain tumor; the patient's condition was provisionally diagnosed as symptomatic epilepsy secondary to brain abscess. His convulsion disappeared soon after administration of antiepileptic, antibacterial, and steroid agents. A craniotomy was performed to evacuate the abscess, and F. necrophorum was identified by culturing the abscess contents. After the operation, he was treated with appropriate antibacterial agents, which resulted in resolution of the brain abscess. Although Fusobacterium species are gram-negative anaerobic bacilli commensal of the human oropharynx, we need to recognize that Fusobacterium species can be a primary pathogen causing brain abscesses and may leave residual neurological sequelae without early appropriate treatment.
在此，我们报告一例78岁健康男性因坏死梭杆菌导致脑脓肿的病例。他出现惊厥，且无任何脑膜炎体征。尽管左侧枕叶的脑磁共振成像结果典型地提示脑脓肿，但他的脑脊液检查仅显示轻度细胞增多和蛋白水平轻度升高。因此，难以排除转移性脑肿瘤的可能性；该患者的病情被初步诊断为继发于脑脓肿的症状性癫痫。给予抗癫痫、抗菌和类固醇药物后，他的惊厥很快消失。进行了开颅手术以引流脓肿，并通过培养脓肿内容物鉴定出坏死梭杆菌。术后，他接受了适当的抗菌药物治疗，脑脓肿得以消退。尽管梭杆菌属是人或口咽部共生的革兰氏阴性厌氧杆菌，但我们需要认识到梭杆菌属可能是导致脑脓肿的主要病原体，若不及早进行适当治疗，可能会留下残余神经后遗症。
