Kimura T, Hashizume K, Tanaka T, Yonemasu Y
Department of Neurosurgery, Asahikawa Medical College, Japan.
No To Shinkei. 1997 Apr;49(4):359-63.
Epidural abscess is very uncommon in the cervical region, and it is difficult to diagnose because of the diversity of its clinical course. The resulting neurological deficits remain unacceptably severe because of delays in diagnosis and treatment. We present a rare case of acute cervical epidural abscess. A 57-year-old man was admitted to our hospital because of esophageal carcinoma. During an overnight stay outside the hospital, he experienced sudden lumbago while removing snow at his home. The next day he developed back pain and high fever. He was drowsy but complained of neck pain. Lumbar puncture was dry. Two hours after the procedure, he developed respiratory arrest and became comatose. Consciousness and motor function recovered in response to artificial ventilation, but tetraplegia developed three days later. Cervical enhanced-CT suggested an epidural abscess. Emergency decompression laminectomy and drainage of the abscess combined with systemic antibiotics was performed. Postoperatively, the patient was afebrile, and his respiration and motor function gradually recovered. The histopathological diagnosis was abscess, but its origin was undetermined.
颈椎硬膜外脓肿在颈部非常罕见,由于其临床病程的多样性,很难进行诊断。由于诊断和治疗的延迟,由此导致的神经功能缺损仍然严重到令人难以接受。我们报告一例罕见的急性颈椎硬膜外脓肿病例。一名57岁男性因食管癌入住我院。在院外过夜期间,他在家中铲雪时突然出现腰痛。第二天,他出现背痛和高热。他嗜睡,但诉说颈部疼痛。腰椎穿刺未抽出脑脊液。操作两小时后,他出现呼吸骤停并昏迷。人工通气后意识和运动功能恢复,但三天后出现四肢瘫痪。颈椎增强CT提示硬膜外脓肿。急诊行减压性椎板切除术、脓肿引流并联合全身使用抗生素。术后,患者体温恢复正常,呼吸和运动功能逐渐恢复。组织病理学诊断为脓肿,但其来源未明。