垂体脓肿的临床与影像学表现(附13例报告)

目的探讨垂体脓肿的临床表现及影像学特点。方法回顾性分析13例经手术及病理证实的垂体脓肿患者的临床及影像学资料。结果垂体脓肿最常见的临床表现为头痛、垂体功能障碍和视觉损害,有感染征象者仅1例。3例行CT,2例行MRI,8例同时行CT和MRI。CT和MRI表现为垂体占位,正常垂体结构消失;病灶CT平扫呈等或低密度;MRT1WI呈稍高、等、低或等高混杂信号,病灶边缘信号相对较高T2WI呈高信号或高低混杂信号,增强后8例病灶呈环状强化,2例无强化;此外有3例见垂体柄增粗强化,2例见临近脑膜强化。结论垂体脓肿的临床及影像学表现无特异性,综合分析两者表现可帮助术前作出正确诊断。     

多房性脑脓肿的临床特点与治疗选择

目的 探讨多房性脑脓肿(MLPBA)患者的临床特征和治疗选择.方法 回顾性分析海军总医院神经外科自1991年至2011年收治的20例MLPBA和69例单房性脑脓肿(ULPBA)患者的临床资料并进行统计学处理.结果 本组MLPBA患者占全部脑脓肿患者的22.5％,2组间患者性别比例、年龄分布、病程时间、脓肿部位、细菌类型、感染途径和临床表现差异无统计学意义(P＞0.05); MLPBA组的细菌培养阳性率和破人脑室率高于ULPBA组,MLPBA和ULPBA的平均脓肿体积分别为8.8 mL和13.3 mL.MLPBA和ULPBA的立体定向治疗复发率分别为26.7％和3.2％,死亡率分别为0％和4.3％.结论 MLPBA并非少见;其脓肿体积小于ULPBA但更易破入脑室;立体定向脓肿穿刺为第一治疗选择;虽有些患者需重复立体定向手术治疗,但总体预后良好.     

脑脓肿与先天性心脏病

本文报告25例伴有先天性心脏病的脑脓肿。年龄从5岁到38岁。最常见的心脏畸形是Fallot四联症,本组则有13例。本组脓肿均位于幕上,多发者占8％。 在19例行脓汁细菌培养病例中,13例培养阴性,6例有细菌生长者中4例致病菌为链球菌。 本组的诊断与定位主要依靠颈动脉造影及A型超声波脑扫描,仅最后2例使用CT定位。 全组25例均于局麻下穿刺抽脓,其中2例穿刺后病情继续恶化发生脑疝而行脓肿切除术。本组术后8例死亡,死亡率为32％。 本文结合文献对本病之病因、发病机理等进行了讨论。     

脑脓肿288例分析

分析288例脑脓肿,91.3％位于天幕上,73.6％见颅内高压三联症,65.6％有定位体征。82％有近期感染史,血源性居多,次为邻近炎症灶,以葡萄球茵、变形杆茵、链球茵等多见。大脑半球脓肿以颈动脉造影(有的可定性诊断),小脑脓肿则以空气或碘水脑室造影为准确,行脓肿穿刺或切除术,手术死亡率17.8％。诊治不及时,有原发病灶,链球菌(特别是厌氧茵)所致,2岁以内,多发脓肿者死亡率较高。     

脑脓肿

脑脓肿是常见的颅内化脓性感染病变,虽然抗菌素已广泛地应用于临床,神经外科的诊治水平亦不断提高,而脑脓肿的发病率和死亡率在近20年来并无显著下降。据估计,在1000例神外科手术中,7例是脑脓肿。其死亡率一般在30～60%。因此,应当加强对化脓性脑膜炎和脑脓肿的防治,以提高我们的医疗质量。     

硬膜下脓肿的临床特点及治疗

正硬膜下脓肿是脓液积聚在硬脑膜与蛛网膜之间的化脓性感染,临床上较少见,多由邻近组织感染蔓延所致,早期无特征性表现,诊断困难,易误诊为慢性硬膜下血肿或硬膜下积液,但病情进展迅速,如不及时治疗,死亡率及致残率均较高。一、病因及发病机制硬膜下脓肿是脓液积聚于硬膜下及蛛网膜之间的化脓性感染,可发生于硬膜下的任何位置,以幕上多见,幕下和椎管内较少见。颅内硬膜下脓肿约占颅内化脓性感染的15%~     

严重颅脑损伤的肺部并发症44例分析

本文分析163例严重颅脑损伤中发生肺部并发症44例,发生率为27％;其中肺部感染41例,神经源性肺水肿3例。提示严重颅脑损伤发生肺部并发症者预后较无肺部并发症者差,死亡率分别为52.3％和31.9％(P<0.05);认为防治肺部并发症是降低颅脑损伤死亡率的重要环节之一。文中对肺部并发症发生原因及治疗等进行了讨论。     

脊柱放线菌感染并发脊髓压迫症(附3例报告)

目的探讨脊柱放线菌感染并发脊髓压迫症的临床和影像学特点及治疗方法。方法回顾性分析3例经病理检查证实的本病患者的临床资料。结果3例患者均有颈、胸脊椎及软组织感染和脊髓压迫症状;MRI示病变椎体骨质破坏,颈、胸硬膜外软组织肿块,脊髓受压。病理学检查组织病理学检查证实3例均为放线菌感染,2例表现为炎性肉芽组织伴微脓肿形成,另1例表现为硬膜外脓肿。均予以脓肿清除、脊髓减压术,并给予4~8周大剂量青霉素G静脉滴注,后改口服维持4~6个月,术后及随访3例患者均取得显著的疗效。结论脊柱放线菌感染并发脊髓压迫症临床和影像学表现无特征性,其确诊依赖于病理学和微生物学检查。脓肿引流、椎管内减压术和大剂量抗生素治疗有效。     

脑血管病患者医院感染状况及其相关因素的研究

目的 研究脑血管病患者医院感染状况及其相关因素.方法 对2108例脑血管病患者临床表现、实验室和影像学检查结果进行监测,统计、分析医院感染的发生率、死亡率、感染部位及其相关因素.结果 本组患者发生医院感染726例(34.4%).医院感染组死亡125例(17.2%),无医院感染组死亡112例(8.1%),两组差异有统计学意义(P＜0.01).医院感染发生部位以呼吸道(64.2%)和泌尿道(21.1%)最常见.高龄、住院时间长、脑出血、意识障碍、有侵入性治疗、高血糖及预防性使用抗生素的患者医院感染发生率显著高于年龄较轻、住院时间短、脑梗死、意识清楚、无侵入性治疗、血糖正常及未预防性使用抗生素的患者(均P＜0.01).结论 脑血管病患者医院感染的发生率高,感染患者的死亡率增高.高龄、住院时间长、脑出血、意识障碍、有侵入性治疗、高血糖和预防性使用抗生素是脑血管病患者并发医院感染的常见相关因素.     

102例细菌性脑脓肿患者17年治疗经验

作者总结1970年1月～1986年12月收治102例细菌性脑脓肿的经验.根据治疗情况分三组:Ⅰ组,脓肿切除组(46例);Ⅱ组,脓肿吸除组(33例);Ⅲ组,保守治疗组(17例).依神经系统检查结果分5级:0级:清醒、无神经系统障碍;1级:清醒、神经功能轻度障碍;2级:嗜睡,神经功能中度障碍;3级:昏睡,神经功能明显障碍;4级:昏迷.男∶女为2∶1,年龄6周～78岁,平均34.9岁,30岁以内占47%,>60岁者为15%.常见病因为邻近部位的感染灶(鼻窦炎、乳突炎、牙周脓肿)19例,其次是先心病(17例),开颅手术史(16例)、肺部感染(9例)及头部外伤史(9例),免疫功能障碍6例,21例病因不明.临床表现以头痛最常见(78例,占76.5%),其次为局灶性定位体征(67例,占65.7%),精神异常(64例,占62.7%),癫痫发作仅26例,占25.5%.).89例单发脓肿,73例多发脓肿(2～13个).39例孤立性脓肿位于右半球、41例在左半球,6例位于小脑,脑干、丘脑及基底节区     

90例脑脓肿的临床特点及治疗分析

目的总结目前脑脓肿的临床特点及其疗效。方法对90例脑脓肿患者的完整资料进行回顾性分析。结果本组脓肿构成比为细菌性脓肿97%,霉菌性脓肿2%,包虫性脓肿1%;细菌培养阳性率为10%,仅有1例CSF培养阳性;多发脑脓肿的治疗效果较单发脑脓肿差,两者比较差异有统计学意义(P<0.01);儿童组和成人组总体疗效差异无统计学意义(P>0.05);鞘内注射联合静滴抗生素疗效与单纯静脉用药差异无统计学意义(P>0.05);脑脓肿的抗菌治疗以三联抗生素即头孢三代 万古霉素 甲硝唑为主,临床有效率达88%(79/90)。结论目前脑脓肿细菌培养阳性率低,对细菌培养阴性者静脉给予头孢三代 甲硝唑 万古霉素是治疗脑脓肿的理想方法。     

儿童脑脓肿

目的分析总结儿童脑脓肿的临床发病特点及治疗经验。方法对1994年12月～2001年9月收治的34例脑脓肿患儿的临床资料进行回顾性分析。结果34例儿童患者占同期全年龄组脑脓肿患者的42.5%(34/80),平均发病年龄为6.68岁,男女之比为1.4∶1。以邻近感染扩散和血源性播散为主要感染途径;脓肿分布以额顶区较为多见(57.9%,22/38);多房性、多发性脓肿和巨大脓肿是儿童脑脓肿特点之一;脓液细菌培养阳性率为38.1%(8/21),以链球菌为多见。14.7%(5/34)的患儿接受单纯穿刺抽吸脓腔冲洗;85.3%(29/34)的患儿施行手术切除,其中全切除率为82.8%(24/29)。1例穿刺后死亡。随访18例,复发率为27.8%(5/18)。结论儿童脑脓肿预后较差。早期诊断、及时进行药物与外科手术联合治疗可望提高疗效。     

Multiple pyogenic brain abscesses: an analysis of 21 patients.

Multiple pyogenic brain abscesses constituted 11.7% (21 patients) of a series of 179 consecutive patients with brain abscess treated from 1976 to 1984. The commonest cause of these abscesses was congenital cyanotic heart disease (38%), followed by middle ear infection (19%). Two thirds of these patients were in the first two decades of life. The clinical presentation was similar to brain abscesses in general, there being no clinical features suggestive of multiple lesions. In 85% the abscesses were supratentorial. Infratentorial abscesses alone or in association with supratentorial abscesses were invariably otogenic in origin. Aspiration of the largest abscesses supplemented with appropriate antibiotics was the treatment of choice in 16 patients; secondary excision of the largest abscesses was required in six patients. Primary excision was performed in three patients when the abscesses were in close proximity to each other. Two patients were managed with antibiotics alone. The overall mortality was 23.8%.     

Value of computed tomography in the diagnosis of intracranial abscess.

The computed tomography (CT) scans of 60 patients with intracranial infection have been reviewed. Computed tomography, particularly if used with contrast enhancement, is a valuable adjunct to the investigation of patients with suspected intracranial abscess. The false negative rate is 1%, but despite this, mortality from intracranial abscess remains unchanged.     

Protean infectious types and frequent association with neurosurgical procedures in adult Serratia marcescens CNS infections: report of two cases and review of the literature

Serratia marcescens is a rare pathogen of adult central nervous system (CNS) infection. We report on the clinical features and therapeutic outcomes of two adult patients with such infections. The clinical characteristics of 13 other reported adult cases are also included for analysis. The 15 cases were nine males and six females, aged 19-83 years, in whom, underlying post-neurosurgical states and ear operation were noted in 93% (14/15). Fever and conscious disturbance were the most common clinical manifestations of these 15 cases, followed by hydrocephalus, seizures, and wound infections. The manifestation types were protean, including meningitis and focal suppurations such as brain abscess, cranial and spinal epidural abscess, cranial subdural abscess, and infected lumbar pseudomeningocele. One case of S. marcescens CNS infection was diagnosed postmortem; the other 14 were diagnosed by the positive culture from CSF or pus. Antibiotic therapy with or without neurosurgical intervention was the management strategy in 14/15 cases. The therapeutic results showed a high mortality rate.     

老年人颅脑外伤并发多器官功能衰竭的临床分析

目的探讨老年颅脑外伤并发多器官功能衰竭(MOF)患者的进展和特点，分析其发病机制及防治措施方法应用同顾性调杏法分析36例MOF患者的临床特征、治疗方法及结果结果36例MOF发生于外伤后平均5d；2、3、4个以上器官衰竭者死亡率分别为52．6％、58．3％、90％；器官衰竭发生顺序依次为：肺、胃肠道、肾、心血管、代谢、血液、免疫系统结论肺部感染是老年颅脑外伤并发MOF最常见的诱因，及时采用预防保护措施可降低老年颅脑外伤患者的致残率、致死率、     

Brain abscess caused by aerobic Gram-negative bacilli: clinical features and therapeutic outcomes

Thirty-three patients (24 males and nine females) with brain abscesses resulting from infection by aerobic Gram-negative bacilli were identified at Kaohsiung Chang Gung Memorial Hospital over a period of 14 years. Of these, 23 cases developed spontaneously, with the remaining ten postneurosurgery. The organisms most frequently involved were Klebsiella (K.) pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus species and included some rare pathogens, such as Salmonella and Enterobacter species, K. oxytoca, Vibrio and Morganella morganii. Apart from one exception, the locations of the abscess were supratentorial. Twenty-four patients presented with a single abscess, while nine revealed multiple abscesses, with 26 treated surgically and seven with antibiotics exclusively. In total, seven patients died, representing an overall mortality rate of 21%. This study demonstrates that brain abscesses associated with neurosurgical procedures are not rare, accounting for 30% of cases in this study, with K. pneumoniae, Proteus and Enterobacter species the most prevalent of the revealed pathogens. Further, Proteus species were the most prevalent pathogens demonstrated for cases of both otogenic and polymicrobial infections. If brain abscesses are diagnosed for diabetic patients or have a gas-forming appearance, a diagnosis of K. pneumoniae infection should be considered, with particular attention paid to detection of other metastatic septic abscesses. In light of the high mortality rate, early treatment is essential to maximize the chances of survival.     

Clinical presentation and outcome of brain abscess over the last 6 years in community based neurological service.

Sixty patients with brain abscess were treated at the Neurosurgical Unit of the Department of Surgery, Hospital Universiti Sains Malaysia between January 1990 and December 1996. A retrospective study was done and data were collected from the computerise d registry of the Record Unit of Hospital Universiti Sains Malaysia. Good results were achieved in patients who were both treated surgically and medically. There were only twelve deaths in this group. The main factor that influences morbidity and mortality of brain abscess is the clinical presentation on admission. The mortality was high in patients treated solely by medical means. Death was common in patients who presented with acute onset of symptoms of less than one week duration and those with poor mental status. Brain abscess is common in the East Coast population of peninsular Malaysia, probably due in part to lower socioeconomic status. Efforts should be directed towards prevention of infection and early recognition and management.     

Cerebellar abscess. A review of 47 cases.

Forty-seven cases of cerebellar abscess have been reviewed, 93% of which were secondary to otogenic disease. There has been little change in the annual incidence during the period of time under review. The overall mortality was 41%, but with successive decades the mortality has increased. Three factors appear to be of importance in determining survival: the patient's ability to control his infection; reduction of the effect of the posterior fossa mass, preferably by complete excision of the abscess under antibiotic cover; and, in the case of otogenic abscess, an adequate radical mastoidectomy with bone removal to the site of attachment of the abscess to the dura mater.     

脑脓肿147例临床分析

目的 进一步探讨脑脓肿发病情况、影像学表现,选择最佳治疗方法,提高治疗效果。方法 回顾分析147例脑脓肿的发病、病因、影像学表现、治疗方法及死亡率下降因素。结果 脑脓肿发病年龄较年青,血源性及隐源性脑脓肿发病率升高,CT结合MRI可明确诊断,选择最佳手术方法。CT应用后死亡率由23．8％下降到7．5％。结论 CT为脑脓肿最主要的诊断方法,CT定位下穿刺排肽可治愈大部分脑脓肿。