Zhou Wei, Shao Xuefei, Jiang Xiaochun
Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China.
Front Neurosci. 2019 Jan 14;12:1054. doi: 10.3389/fnins.2018.01054. eCollection 2018.
Brain abscess, a severe intracranial infectious disease, refers to the parenchyma abscess caused by local infection or remote spread. Recently, advancements in modern medicine, especially the wide application of antimicrobial drugs, have contributed to the gradual decrease in the prevalence of this disease. However, cases of cryptogenic brain abscess that feature an unknown origin and atypical symptoms are rising. In this retrospective study, we report and analyze two cases of cryptogenic brain abscess. The first patient was a 30-year-old healthy man who was admitted to our hospital due to 1 week of headache and 3 days of headache aggravation, accompanied by nausea and vomiting. Head MRI shows a circular space-occupying as well as apparently enhanced DWI signals were observed in the right parietal lobe, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was diagnosed as a brain abscess before operation and given craniotomy. The postoperative pathology confirmed brain abscess and recovered well after surgery. The second patient was a 45-year-old healthy woman who was hospitalized in a local hospital due to symptoms of headache and right limb weakness for 1 week. Head MRI shows a circular space-occupying lesion in the left basal ganglia, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was suspected of glioma at the local hospital and was transferred to our hospital. Twelve hours after hospitalization, the patient was suspected of developing cerebral palsy and thus underwent emergency surgery including lesion resection in the left basal ganglia, resection of the polus temporalis, and a decompressive craniotomy. Postoperative pathology confirmed brain abscess. The patient was eventually conscious, but left the right limb hemiplegia. Hence, when a patient develops the classical triad of fever, headache, and focal neurologic deficits, the possibility of brain abscess should be investigated. Early diagnosis and treatment are crucial to minimize various complications and the number of deaths.
脑脓肿是一种严重的颅内感染性疾病，指由局部感染或远处播散引起的脑实质脓肿。近年来，现代医学的进步，尤其是抗菌药物的广泛应用，促使该疾病的发病率逐渐下降。然而，病因不明且症状不典型的隐源性脑脓肿病例却在增加。在这项回顾性研究中，我们报告并分析了两例隐源性脑脓肿病例。首例患者为一名30岁的健康男性，因头痛1周、头痛加重3天入院，伴有恶心和呕吐。头部磁共振成像（MRI）显示右侧顶叶有一个圆形占位，弥散加权成像（DWI）信号明显增强，增强后环形壁信号强度明显增加。患者术前被诊断为脑脓肿并接受了开颅手术。术后病理证实为脑脓肿，术后恢复良好。第二例患者是一名45岁的健康女性，因头痛和右下肢无力症状1周在当地医院住院。头部MRI显示左侧基底节有一个圆形占位性病变，增强后环形壁信号强度明显增加。该患者在当地医院被怀疑患有胶质瘤，随后被转至我院。入院12小时后，患者被怀疑发生脑瘫，因此接受了急诊手术，包括左侧基底节病变切除、颞极切除和减压性开颅手术。术后病理证实为脑脓肿。患者最终清醒，但遗留右侧肢体偏瘫。因此，当患者出现发热、头痛和局灶性神经功能缺损这一典型三联征时，应排查脑脓肿的可能性。早期诊断和治疗对于减少各种并发症及死亡人数至关重要。
