Kon H, Kumabe T, Tominaga T, Mizoi K
Department of Neurosurgery, Tohoku University School of Medicine.
No Shinkei Geka. 1997 May;25(5):455-9.
We report a case of a brain abscess which initially presented with subcortical hematoma and ultimately resulted in fatal brain stem infarction due to its rupture into the subarachnoid space. A 50-year-old male was admitted to a nearby hospital with complaints of headache, fever, and sensory aphasia. He had ventricular septal defect found 15 years previously, sinusitis, and liver cirrhosis. Computerized tomographic (CT) scan revealed a left temporal subcortical hematoma. Gadolinium-DTPA enhanced magnetic resonance imaging (MRI) showed faint ring-like enhancement at the margin of the lesion. The left internal carotid angiogram demonstrated the vascular blush and early venous filling of the vein of Labbé. Administration of antibiotics and predonine resulted in resolution of fever within five days. MRI obtained 17 days after the onset showed typical ring-like enhancement. The mass was just adjacent to the lateral ventricle. The patient was transferred to our hospital for further examination and treatment 21 days after the onset. Fever had recurred 2 days before admission to our hospital. One day after admission, the patient began to vomit. About 15 hours following this symptom, he suddenly became comatose and tetraplegic. CT scan demonstrated a rupture of the abscess. Emergent drainage from the lateral ventricle and the abscess cavity was undertaken. Follow-up CT scan revealed multiple infarctions involving the upper brain stem and the bilateral thalamus. He died on the 29th day after the onset. The mechanisms of hemorrhage with a brain abscess and cerebral infarction after rupture of brain abscess are discussed. Hemorrhage with brain abscess is extremely rare. However, brain abscess should be considered as a possible etiology of an atypical hematoma. To avoid fatal rupture of the brain abscess, immediate treatment is essential. Once the rupture of the brain abscess occurs, its contents might cause vasospasm severe enough to cause cerebral infarction.
我们报告一例脑脓肿病例，该病例最初表现为皮质下血肿，最终因脓肿破入蛛网膜下腔导致致命的脑干梗死。一名50岁男性因头痛、发热和感觉性失语入住附近医院。他15年前被发现患有室间隔缺损、鼻窦炎和肝硬化。计算机断层扫描（CT）显示左侧颞叶皮质下血肿。钆喷酸葡胺增强磁共振成像（MRI）显示病变边缘有微弱的环状强化。左侧颈内动脉血管造影显示有血管造影剂外溢和Labbe静脉早期充盈。使用抗生素和泼尼松后，发热在五天内消退。发病17天后进行的MRI显示典型的环状强化。肿块紧邻侧脑室。发病21天后，患者被转至我院进一步检查和治疗。入院前两天发热再次出现。入院一天后，患者开始呕吐。出现该症状约15小时后，他突然昏迷并四肢瘫痪。CT扫描显示脓肿破裂。紧急进行了侧脑室和脓肿腔引流。后续CT扫描显示累及上脑干和双侧丘脑的多发性梗死。患者在发病后第29天死亡。文中讨论了脑脓肿出血的机制以及脑脓肿破裂后脑梗死的机制。脑脓肿出血极为罕见。然而，脑脓肿应被视为非典型血肿的一种可能病因。为避免脑脓肿致命性破裂，立即治疗至关重要。一旦脑脓肿破裂，其内容物可能导致严重的血管痉挛，进而引起脑梗死。
