Corazzelli Giuseppe, Corvino Sergio, Noto Giulio Di, Germano Cristiana, Buonamassa Simona, Colandrea Salvatore Di, de Falco Raffaele, Bocchetti Antonio
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
Department of Neurosurgery, Messina University - Policlinico G. Martino, Messina, Italy.
Surg Neurol Int. 2024 Feb 9;15:42. doi: 10.25259/SNI_965_2023. eCollection 2024.
Focal suppurative bacterial infections of the central nervous system (CNS), such as subdural empyemas and brain abscesses, can occur when bacteria enter the CNS through sinus fractures, head injuries, surgical treatment, or hematogenous spreading. Chronic cocaine inhalation abuse has been linked to intracranial focal suppurative bacterial infections, which can affect neural and meningeal structures.
We present the case of a patient who developed a cocaine-induced midline destructive lesion, a vast bilateral paraclinoidal subdural empyema, and intracerebral right temporopolar abscess due to cocaine inhalation abuse. The infection disseminated from the nasal and paranasal cavities to the intracranial compartment, highlighting a unique anatomical pathway.
The treatment involved an endoscopic endonasal approach, followed by a right frontal-temporal approach to obtain tissue samples for bacterial analysis and surgical debridement of the suppurative process. Targeted antibiotic therapy helped restore the patient's neurological status.
当细菌通过鼻窦骨折、头部受伤、外科治疗或血行播散进入中枢神经系统（CNS）时，可发生中枢神经系统的局灶性化脓性细菌感染，如硬膜下积脓和脑脓肿。长期滥用可卡因吸入与颅内局灶性化脓性细菌感染有关，可影响神经和脑膜结构。
我们报告一例因滥用可卡因吸入导致可卡因诱导的中线破坏性病变、广泛的双侧鞍旁硬膜下积脓和右侧颞极脑脓肿的患者。感染从鼻腔和鼻窦扩散至颅内腔隙，凸显了一条独特的解剖学途径。
治疗采用内镜鼻内入路，随后采用右侧额颞入路获取组织样本进行细菌分析，并对化脓过程进行手术清创。针对性的抗生素治疗有助于恢复患者的神经状态。
