Neromyliotis Eleftherios, Giakoumettis Dimitrios, Drosos Evangelos, Nikas Ioannis, Blionas Alexios, Sfakianos George, Themistocleous Marios S
Department of Neurosurgery, Children's Hospital 'Aghia Sofia', Athens, Greece.
Department of Neurosurgery, University of Athens Medical School, "Evangelismos" General Hospital, Athens, Greece.
Surg Neurol Int. 2018 May 24;9:104. doi: 10.4103/sni.sni_394_17. eCollection 2018.
Infratentorial subdural empyemas in children are extremely rare and potentially lethal intracranial infections. Delay in diagnosis and therapy is associated with increased morbidity and mortality.
A 4-year-old boy presented with cerebellar signs following a failed treatment of otitis media. Imaging studies revealed a subdural empyema and left transverse and sigmoid sinus thrombosis. The empyema was evacuated operatively and antibiotic treatment was initiated and administered for 6 weeks. The patient recovered fully and was discharged 4 weeks following the evacuation of the empyema.
While prompt identification and treatment of subdural infratentorial empyemas are crucial for favorable outcomes, their diagnosis in children might be initially missed. This is, in part because they are so rare and in part, because imaging artifacts arising from the complex posterior fossa anatomy may obscure their presence in the computer tomography (CT) scan. Therefore, high level of suspicion is necessary, given the appropriate history and clinical presentation. In children, this is a recent history of protracted otitis media and central nervous system symptomatology-cerebellar or other.
儿童幕下硬膜下积脓是极为罕见且具有潜在致命性的颅内感染。诊断和治疗的延迟与发病率和死亡率的增加相关。
一名4岁男孩在中耳炎治疗失败后出现小脑体征。影像学检查显示硬膜下积脓以及左侧横窦和乙状窦血栓形成。通过手术引流积脓，并开始使用抗生素治疗，持续6周。患者完全康复，在积脓引流4周后出院。
虽然及时识别和治疗幕下硬膜下积脓对于取得良好预后至关重要，但在儿童中其诊断最初可能会被漏诊。部分原因是它们非常罕见，部分原因是复杂的后颅窝解剖结构产生的影像伪影可能会在计算机断层扫描（CT）中掩盖它们的存在。因此，鉴于适当的病史和临床表现，高度怀疑是必要的。在儿童中，这通常是近期有迁延性中耳炎病史以及中枢神经系统症状——小脑或其他症状。
