Aoki N, Sakai T, Oikawa A, Takizawa T, Shishido T
Department of Neurosurgery, Tokyo Metropolitan Ohkubo Hospital.
Neurol Med Chir (Tokyo). 1997 Aug;37(8):637-9. doi: 10.2176/nmc.37.637.
A 70-year-old male presented with rapid neurological deterioration and fever 3 months after suffering a closed head trauma. He underwent craniotomy for possible subdural empyema based on computed tomography and clinical findings. Dural incision revealed an outer membrane typical of chronic subdural hematoma which covered a clear, yellowish fluid containing Campylobacter fetus. Histological examination confirmed the capsule of the hematoma, with a necrotic focus infiltrated by neutrophils. Administration of intravenous imipenem and topical tobramycin and cefalothin achieved total resolution of his neurological deficits. Development of the infected subdural effusion was probably secondary to bacterial infection in the pre-existing chronic subdural hematoma in the resolving stage. The presence of the hematoma capsule always carries the risk of development of an infectious focus.
一名70岁男性在闭合性颅脑外伤3个月后出现快速神经功能恶化和发热。基于计算机断层扫描和临床检查结果，他因可能的硬脑膜下积脓接受了开颅手术。硬脑膜切开显示出一层典型的慢性硬脑膜下血肿外层膜，其覆盖着一种清澈、淡黄色的液体，其中含有胎儿弯曲杆菌。组织学检查证实了血肿包膜，有一个被中性粒细胞浸润的坏死灶。静脉注射亚胺培南以及局部使用妥布霉素和头孢噻吩使他的神经功能缺损完全恢复。感染性硬脑膜下积液的发生可能继发于正在吸收阶段的既往慢性硬脑膜下血肿中的细菌感染。血肿包膜的存在始终存在形成感染灶的风险。
