Munusamy Thangaraj, Dinesh Shree Kumar
Department of Neurosurgery, National Neuroscience Institute, Singapore.
J Neurol Surg Rep. 2015 Jul;76(1):e79-82. doi: 10.1055/s-0035-1547366. Epub 2015 Mar 23.
Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature.
硬膜下积脓是一种罕见但严重的颅内感染，需要及时处理以降低发病率并避免死亡。然而，其临床和影像学特征可能不明显或模棱两可。因此，硬膜下积脓的诊断不应被忽视，尤其是在有头部外伤史的患者中。治疗包括手术以确定细菌学诊断并随后指导抗生素治疗。在此，我们报告一例老年患者头部受伤后发生的迟发性大肠杆菌硬膜下积脓病例，该患者无明显危险因素。计算机断层扫描成像对于硬膜下积脓的诊断不明确。患者接受了手术并接受了静脉抗生素治疗。尽管观察到患者的临床状况最初有所改善，但他最终死于医院获得性肺炎。在本文中，我们讨论了硬膜下积脓的临床表现、诊断工具和治疗选择，重点关注其中的挑战。随后出现的管理难题促使我们对文献进行了回顾。
