Shimura T, Nakazawa S, Kuzuhara M, Adachi K
Dept. of Neurosurgery, Nippon Medical School.
Gan To Kagaku Ryoho. 1988 Oct;15(10):2999-3002.
This is an autopsy case report of a 52-year-old woman with a brain abscess presenting as an intracerebral gas shadow on CT scan. She was admitted to our facility in June 1977, with disorientation and motor weakness of the right upper extremities. CT scan revealed two separate mass lesions in the frontal and occipital lobes on the left side. She was diagnosed as having metastatic carcinoma, and was treated by tumor removal, radiation therapy, and intraneoplastic local chemotherapy. Seventeen months later, she was readmitted with decreased mental activity, hemiconvulsion of the right side and high fever. CT scan revealed a peculiar round gas shadow on the left side of the temporal lobe. Ventricular drainage produced a cloudy cerebrospinal fluid with a protein concentration of more than 400 mg/dl and a leucocyte count of 138,200. An anaerobic culture of the ventricular cerebrospinal fluid revealed Escherichia coli. At that time, the lateral ventricle was irrigated several times with antibiotics. Unfortunately, however, she died one year after readmission. An autopsy was performed shortly after death, at which time serial coronal sectioning of the brain confirmed the CT scan findings presenting as an intracerebral gas shadow, and further demonstrated extension of the brain abscess from the left temporal lobe to the temporal horn of the lateral ventricle. The lesion in the left temporal lobe included yellowish pus with partially brownish capsules. A gas-containing brain abscess confirmed by CT scan and autopsy is rarely seen. The Hounsfield unit obtained from the abscess cavity by utilizing serial CT scan sometimes represents a condition requiring urgent treatment for brain abscess.
这是一例52岁女性脑脓肿的尸检病例报告，CT扫描显示为脑内气体阴影。她于1977年6月入住我院，表现为定向障碍和右上肢运动无力。CT扫描显示左侧额叶和枕叶有两个独立的肿块病变。她被诊断为转移性癌，并接受了肿瘤切除、放射治疗和瘤内局部化疗。17个月后，她因精神活动减退、右侧半身惊厥和高热再次入院。CT扫描显示颞叶左侧有一个特殊的圆形气体阴影。脑室引流引出浑浊的脑脊液，蛋白质浓度超过400mg/dl，白细胞计数为138,200。脑室脑脊液厌氧培养显示大肠杆菌。当时，用抗生素对侧脑室进行了多次冲洗。然而，不幸的是，她再次入院一年后死亡。死后不久进行了尸检，此时对大脑进行系列冠状切片证实了CT扫描显示的脑内气体阴影，并进一步显示脑脓肿从左侧颞叶延伸至侧脑室颞角。左侧颞叶病变包括淡黄色脓液，部分有褐色包膜。经CT扫描和尸检证实的含气脑脓肿很少见。利用系列CT扫描从脓肿腔获得的亨氏单位有时代表一种需要对脑脓肿进行紧急治疗的情况。
