Yamasaki F, Kodama Y, Hotta T, Taniguchi E, Hashizume A, Kajiwara Y, Yamane T
Department of Neurosurgery, Kure National Hospital, Japan.
No To Shinkei. 1997 Jan;49(1):81-4.
The authors report a case of so-called "infected subdural hematoma" as a complication of chronic subdural hematoma. The patient was a 55-year-old man who had sustained a small laceration of the forehead in a traffic accident on March 29, 1995. No fractures were detected on skull roentgenograms, and general and neurological examinations failed to reveal any abnormal findings. In early August 1995, the patient began to experience headaches, and on August 5 he developed a fever of 38 degrees C. On August 8 he suffered a left motor seizure and was admitted to our hospital. Laboratory studies revealed a peripheral leukocyte count of 10,800/mm3 and a C-reactive protein level of 18.1 mg/dl. Computed tomography scans showed a thick right fronto-parietal subdural low density mass and a thin left frontal subdural low density mass. An emergency operation was performed via a single right fronto-parietal burr hole. A chronic subdural hematoma containing slightly yellowish, bloody, purulent fluid was found beneath an outer membrane. The hematoma was irrigated with physiological saline containing antibiotics, and a drain was inserted into the subdural space. A subdural membrane was also present on the left but it contained no pus. Aggressive antibiotic therapy was performed, and the patient was discharged without any neurological deficit. Histologically the membrane was determined to be the outer membrane of a typical chronic subdural hematoma. Enterococcus faecalis, which has rarely been reported to cause infection of the central nervous system, was detected in a bacterial culture of the pus. Systemic investigation showed no evidence of otorhinologic or other focal infection. The above clinical findings suggested that hematogenous seeding of a chronic subdural hematoma had occurred in this patient. Subdural empyema arising from hematogenous seeding to a pre-existing subdural hematoma by an infection is very rare, but this type of complication must be kept in mind not only in the elderly, infants, and compromised hosts, but in patients without complications as well.
作者报告了一例所谓“感染性硬膜下血肿”作为慢性硬膜下血肿并发症的病例。患者为一名55岁男性，于1995年3月29日在交通事故中前额有一处小裂伤。颅骨X线片未发现骨折，全身及神经系统检查未发现任何异常。1995年8月初，患者开始出现头痛，8月5日体温升至38摄氏度。8月8日发生左侧运动性癫痫发作，随后入住我院。实验室检查显示外周白细胞计数为10,800/mm³，C反应蛋白水平为18.1mg/dl。计算机断层扫描显示右侧额顶硬膜下有一厚层低密度肿块以及左侧额叶硬膜下有一薄层低密度肿块。通过单个右侧额顶骨钻孔进行了急诊手术。在外膜下发现了一个含有微黄、血性、脓性液体的慢性硬膜下血肿。用含抗生素的生理盐水冲洗血肿，并在硬膜下间隙插入引流管。左侧也存在硬膜下膜，但其中没有脓液。进行了积极的抗生素治疗，患者出院时无任何神经功能缺损。组织学检查确定该膜为典型慢性硬膜下血肿的外膜。在脓液的细菌培养中检测到很少有报道引起中枢神经系统感染的粪肠球菌。全身检查未发现耳鼻喉科或其他局部感染的证据。上述临床发现提示该患者发生了慢性硬膜下血肿的血行播散。由感染血行播散至先前存在的硬膜下血肿而引起的硬膜下积脓非常罕见，但不仅在老年人、婴儿和免疫功能低下的宿主中，而且在无并发症的患者中也必须牢记这种类型的并发症。
