Kaminogo M, Kurihara M, Kawano T, Mori K, Yasuda M
No Shinkei Geka. 1984 Mar;12(3 Suppl):353-7.
A 76-year-old female was admitted with a headache. She had no febrile course before admission. Computed tomography (CT) demonstrated bilateral frontal hypodense areas without enhanced rim. She was made a diagnosis of a chronic subdural hematoma. Because her general condition was poor and she had no neurological deficit, she was planned to be treated conservatively. On a few days after the admission, she was suffered from agranulocytosis. However, leukopenia disappeared within a few days by the effective treatment and any neurological deficit was not observed in these period. On thirty days after the admission, she rapidly became semicomatous state and showed left side hemiparesis. A subdural empyema was demonstrated by the subsequent operation. Both culture of subdural fluid and urine yielded Escherichia coli. Her neurological deficits cleared after the operation and subsequent antibiotic therapy. We speculated that infection of urinary tract produced a E. coli bacteremia and subsequently infected subdural hematoma occurred by this microorganism. We stressed that when the neurological deterioration was observed during the conservative treatment of chronic subdural hematoma, infected hematoma would be one which should be one differentiated from an enlargement of hematoma. The mechanisms of the rim enhancement observed at CT are also discussed.
一名76岁女性因头痛入院。入院前无发热病程。计算机断层扫描（CT）显示双侧额叶低密度区，无强化边缘。她被诊断为慢性硬膜下血肿。由于她的一般状况较差且无神经功能缺损，计划对其进行保守治疗。入院后几天，她出现了粒细胞缺乏症。然而，经过有效治疗，白细胞减少症在几天内消失，在此期间未观察到任何神经功能缺损。入院30天后，她迅速陷入半昏迷状态，并出现左侧偏瘫。随后的手术显示为硬膜下积脓。硬膜下积液和尿液培养均检出大肠杆菌。术后及随后的抗生素治疗后，她的神经功能缺损得以清除。我们推测尿路感染产生大肠杆菌菌血症，随后该微生物感染了硬膜下血肿。我们强调，在慢性硬膜下血肿的保守治疗过程中观察到神经功能恶化时，感染性血肿是需要与血肿扩大相鉴别的一种情况。还讨论了CT上观察到的边缘强化的机制。
