Yokote H, Terada T, Nakai K, Itakura T
Department of Neurological Surgery, Wakayama Medical College, Wakayama City, Japan.
Neurosurgery. 1997 May;40(5):1071-3; discussion 1073-4. doi: 10.1097/00006123-199705000-00036.
The first case of Wegener's granulomatosis associated with subdural empyema is presented.
A 37-year-old man was admitted to our hospital for treatment of bilateral subdural masses. Magnetic resonance imaging demonstrated strong bilateral subdural and meningeal enhancement. The patient was treated with subdural drainage, based on the diagnosis of bilateral subdural hematoma or empyema as revealed by magnetic resonance imaging. Even after surgery, he developed systemic symptoms that are typical for Wegener's granulomatosis, including hemosputum, papules, peripheral nervous disorders, hematuria, myalgia, and joint pain. A diagnosis of Wegener's granulomatosis was confirmed by positive circulating antineutrophil cytoplasmic antibodies and histological findings from the skin and nasal mucosa. We diagnosed the subdural masses as Wegener's granulomatosis from the laboratory and neuroimaging studies, retrospectively.
Pus-like fluid containing hematoma with negative micro-organism was evacuated by surgery.
Wegener's granulomatosis should be suspected in young patients with pulmonary symptoms and subdural hematoma without head injury. This is the first case of Wegener's granulomatosis associated with subdural masses.
本文报告首例韦格纳肉芽肿合并硬脑膜下积脓的病例。
一名37岁男性因双侧硬脑膜下肿块入院治疗。磁共振成像显示双侧硬脑膜下及脑膜强化明显。根据磁共振成像显示的双侧硬脑膜下血肿或积脓诊断，患者接受了硬脑膜下引流治疗。即便术后，他仍出现了韦格纳肉芽肿典型的全身症状，包括咯血、丘疹、周围神经病变、血尿、肌痛和关节疼痛。循环抗中性粒细胞胞浆抗体阳性以及皮肤和鼻黏膜的组织学检查结果确诊为韦格纳肉芽肿。回顾性地，我们通过实验室检查和神经影像学研究将硬脑膜下肿块诊断为韦格纳肉芽肿。
手术清除了含有血肿且微生物检测阴性的脓性液体。
对于有肺部症状且无头部外伤的硬脑膜下血肿年轻患者，应怀疑韦格纳肉芽肿。这是首例韦格纳肉芽肿合并硬脑膜下肿块的病例。
