Geiser Rachel, Zorio Onilia, Appavu Brian
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.
Department of Neurology, Phoenix Children's Hospital, Phoenix, AZ, USA.
J Child Neurol. 2025 Aug;40(7):563-565. doi: 10.1177/08830738251339048. Epub 2025 May 16.
and are anaerobic gram-negative rods that exist in the oral cavity. To our knowledge, pediatric central nervous system complications with these pathogens have not been well described. An 11-year-old previously healthy vaccinated female child presented for 2 weeks of sinusitis that progressed to left arm and leg hemiplegia. Initial neuroimaging demonstrated a superior sagittal sinus thrombosis and a right hemispheric subdural empyema with midline shift, necessitating surgical evacuation. Culture of the subdural accumulation demonstrated coinfection of and . Within 24 hours of evacuation, the patient progressed to have right hemispheric electrographic status epilepticus, with neuroimaging demonstrating reaccumulation of the empyema and a moderate right middle cerebral artery vasospasm. Transcranial doppler ultrasonography of the right middle cerebral artery territory demonstrated mean flow velocities up to 148 cm/s with a Lindengaard ratio of 3.44. The patient underwent repeat subdural evacuation and was managed with intravenous fluids, permissive hypertension, oral nimodipine, and intravenous milrinone. Electrographic status epilepticus was treated with intravenous lacosamide and levetiracetam. Repeat neuroimaging demonstrated improvement in subdural collection size and resolution of vasospasms. She was discharged after 16 days with continued lacosamide and levetiracetam for seizures, and enoxaparin (Lovenox) for the superior sagittal sinus thrombosis. We present a novel pediatric case of and manifesting with rapid subdural empyema reaccumulation after surgical evacuation, status epilepticus, cerebrovascular vasospasms, and cerebral sinus venous thrombosis. Further work is needed to understand the potential neurologic complications of this condition.
[细菌名称1]和[细菌名称2]是存在于口腔中的厌氧革兰氏阴性杆菌。据我们所知，这些病原体导致的小儿中枢神经系统并发症尚未得到充分描述。一名11岁、既往健康且接种过疫苗的女童因鼻窦炎持续2周，病情进展为左臂和腿部偏瘫。初始神经影像学检查显示上矢状窦血栓形成以及右侧半球硬膜下积脓伴中线移位，需要进行手术引流。硬膜下积液培养显示[细菌名称1]和[细菌名称2]混合感染。在引流后24小时内，患者进展为右侧半球脑电图癫痫持续状态，神经影像学检查显示积脓再次积聚以及右侧大脑中动脉中度血管痉挛。右侧大脑中动脉区域的经颅多普勒超声检查显示平均流速高达148厘米/秒，林登加德比率为3.44。患者接受了重复硬膜下引流，并接受静脉输液、允许性高血压、口服尼莫地平和静脉注射米力农治疗。脑电图癫痫持续状态采用静脉注射拉科酰胺和左乙拉西坦治疗。重复神经影像学检查显示硬膜下积液大小改善以及血管痉挛消退。她在16天后出院，继续服用拉科酰胺和左乙拉西坦治疗癫痫，服用依诺肝素（洛伐诺克斯）治疗上矢状窦血栓形成。我们报告了一例新颖的小儿病例，[细菌名称1]和[细菌名称2]感染表现为手术引流后硬膜下积脓快速再次积聚、癫痫持续状态、脑血管痉挛和脑静脉窦血栓形成。需要进一步开展工作以了解这种情况潜在的神经系统并发症。
