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髓质脓肿:一种罕见的临床表现。

Medullary abscess: a rare clinical presentation.

作者信息

Muranovs Pavels, Gillon Claire, Norris John

机构信息

Neurosurgery, Royal Sussex County Hospital, Brighton, UK

Neurosurgery, Royal Sussex County Hospital, Brighton, UK.

出版信息

BMJ Case Rep. 2020 Mar 10;13(3):e233286. doi: 10.1136/bcr-2019-233286.

Abstract

Brain abscesses represent areas of localised infection of the brain parenchyma. Those confined to the brainstem are rare and usually fatal if untreated. is a common causative organism of brain abscesses and is associated with significant morbidity. We describe a case report of medullary abscess secondary to dental infection in a 68-year-old patient. The patient presented with headaches and flu-like symptoms progressing to left hemiparesis and reduced consciousness/bulbar function. The patient underwent emergency posterior fossa craniectomy and drainage with subsequent medical management with antibiotics. Prompt diagnosis, early surgical intervention and maximal therapy with antibiotics alongside extensive rehabilitation are all vital to ensure good neurological outcome. It is imperative for medical practitioners to consider the diagnosis of brain abscess in patients presenting with rapid onset neurological deterioration. Such cases require early neurological imaging with involvement of tertiary neurosurgery services.

摘要

脑脓肿是脑实质局部感染的区域。局限于脑干的脑脓肿很少见,如果不治疗通常会致命。[原文此处应有具体致病菌名称未给出]是脑脓肿的常见致病菌,且与显著的发病率相关。我们报告一例68岁患者因牙源性感染继发延髓脓肿的病例。患者最初表现为头痛和类似流感的症状,随后进展为左侧偏瘫、意识减退/延髓功能障碍。患者接受了急诊后颅窝颅骨切除术和引流,随后接受抗生素药物治疗。及时诊断、早期手术干预、使用抗生素的最大程度治疗以及广泛的康复治疗对于确保良好的神经功能预后都至关重要。对于出现快速进展性神经功能恶化的患者,医生必须考虑脑脓肿的诊断。此类病例需要早期进行神经影像学检查,并由三级神经外科服务团队参与治疗。

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本文引用的文献

1
Brain abscess: Current management.脑脓肿:当前的治疗方法。
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2
The role of Streptococcus intermedius in brain abscess.中间链球菌在脑脓肿中的作用。
Eur J Clin Microbiol Infect Dis. 2013 Apr;32(4):477-83. doi: 10.1007/s10096-012-1782-8. Epub 2012 Nov 28.
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Bacterial abscess of the medulla oblongata.延髓细菌性脓肿
J Clin Neurosci. 2009 Aug;16(8):1082-4. doi: 10.1016/j.jocn.2008.08.010. Epub 2009 May 5.
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Abscess of the medulla oblongata following endotracheal intubation.气管插管后延髓脓肿
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7
10
Pyogenic abscess of the medulla oblongata.延髓脓性脓肿
Neurosurgery. 1986 Mar;18(3):370-2. doi: 10.1227/00006123-198603000-00024.

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