RESUMO
RATIONALE: A subdural empyema (SDE) following burr hole drainage of a chronic subdural hematoma (CSDH) can be difficult to distinguish from a recurrence of the CSDH, especially when imaging data is limited to a computed tomography (CT) scan. PATIENTS CONCERNS: All patients underwent burr hole drainage of the CSDH at first, and the appearance of the SDE occurred within one month. DIAGNOSES: A contrast-enhanced magnetic resonance imaging (MRI) scan, with diffusion-weighted imaging (DWI), revealed both the SDE and diffuse meningitis in all patients. INTERVENTIONS: In Case 1, because the patient was very young, burr hole drainage of the SDE, rather than craniotomy, was performed. However, subsequent craniotomy was required due to recurrence of the SDE. In Cases 2 and 3, an initial craniotomy was performed without burr hole drainage. OUTCOMES: Symptoms improved for all patients, and each was discharged without any neurologic deficits or subsequent recurrence. LESSONS: Neurosurgeons should consider the possibility of infection if recurrence of CSDH occurs within 1 month following drainage of a subdural hematoma. A contrast-enhanced MRI with DWI should be performed to differentiate SDE from CSDH. In addition, surgical evacuation of the empyema via wide craniotomy is preferred to burr hole drainage.
Assuntos
Craniotomia/métodos , Drenagem , Empiema Subdural , Hematoma Subdural Crônico , Complicações Pós-Operatórias , Espaço Subdural/diagnóstico por imagem , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Precisão da Medição Dimensional , Drenagem/efeitos adversos , Drenagem/métodos , Empiema Subdural/diagnóstico , Empiema Subdural/etiologia , Empiema Subdural/fisiopatologia , Empiema Subdural/cirurgia , Hematoma Subdural Crônico/diagnóstico , Hematoma Subdural Crônico/cirurgia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Multimodal intracranial monitoring is becoming an increasingly common tool in the management of patients with traumatic brain injury. Although numerous reports detailing the benefits of such advanced monitoring exist in the literature, there is minimal discussion of the possible complications that may arise in this patient population. CASE DESCRIPTION: We report the case of a 32-year-old patient who had been assaulted and presented initially at an outside facility with a Glasgow Coma Scale score of 8. After transfer to our hospital, his Glasgow Coma Scale score was noted at 7T and multimodal monitoring with the Integra Licox brain tissue oxygen monitor and the Hemedex Bowman perfusion monitor was implemented, along with an external ventricular drain when a standard intracranial pressure monitor indicated increasing intracranial pressure. The patient's intracranial pressure normalized but he did require a course of antibiotics during this time for a fever and methicillin-resistant Staphylococcus aureus. The patient subsequently developed multifocal subdural empyemas requiring surgical evacuation. Postoperatively, the patient's intraoperative cultures remained without bacterial growth, likely related to the 2-week broad-spectrum antibiotic use. CONCLUSIONS: To our knowledge, this is the first reported incidence of a subdural empyema developing in this setting. Although the safety profile of multimodal intracranial modeling is excellent, with increasing numbers of invasive bedside procedures, neurosurgeons must remain acutely vigilant for the development of infectious complications.
Assuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/fisiopatologia , Encéfalo/irrigação sanguínea , Infecção Hospitalar/etiologia , Infecção Hospitalar/fisiopatologia , Empiema Subdural/etiologia , Empiema Subdural/fisiopatologia , Hematoma Subdural/diagnóstico , Hematoma Subdural/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/efeitos adversos , Monitorização Fisiológica/instrumentação , Oxigênio/sangue , Adulto , Lesões Encefálicas Traumáticas/cirurgia , Derivações do Líquido Cefalorraquidiano , Infecção Hospitalar/cirurgia , Imagem de Difusão por Ressonância Magnética , Empiema Subdural/cirurgia , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/fisiopatologia , Hemorragias Intracranianas/cirurgia , Imageamento por Ressonância Magnética , Masculino , Monitorização Fisiológica/métodos , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Salmonella intracranial infections, including subdural empyema and brain abscess, are rare clinical manifestations in children. The aim of this study is to investigate the clinical course of Salmonella subdural empyema in infants and children. METHODS: We report a 9-month-old female infant diagnosed as Salmonella subdural empyema with clinical features of prolonged fever for more than 2 months and episodic focal seizures. Literature published between 1986 and 2010 relevant to Salmonella subdural empyema in children were reviewed. The clinical presentations and laboratory findings were analyzed. RESULTS: Seventeen cases with Salmonella subdural empyema, including our index case, has been reported with detailed clinical presentation. Fever (17/17; 100%), symptoms and signs of increased intracranial pressure (8/17; 47%), seizures (8/17; 47%), and limb paralysis (8/17; 47%) were the most frequent clinical features. Among these cases, unknown causative organism prior to surgery (11/17; 65%) and prolonged fever for more than 3 weeks (5/17; 29%) were also noticed. Sixteen out of 17 patients (94%) required surgical intervention for treatment. The morbidity rate and mortality rate were 29% (5/17) and 6% (1/17), respectively. CONCLUSION: Subdural empyema is considered to be a disease with rapid progression. However, the cases caused by Salmonella species may present a slow disease course. Surgical intervention is sometimes the only way to detect the pathogen.
Assuntos
Empiema Subdural/microbiologia , Empiema Subdural/fisiopatologia , Infecções por Salmonella/fisiopatologia , Antibacterianos/uso terapêutico , Empiema Subdural/tratamento farmacológico , Feminino , Humanos , Lactente , Infecções por Salmonella/tratamento farmacológicoRESUMO
INTRODUCTION: We describe a previously unreported 437 TâG missense mutation producing a V146G substitution in the first coiled-coil (CC1) domain of nuclear factor-κB essential modulator (NEMO) in a 9-month-old boy with ectodermal dysplasia with immunodeficiency who presented with methicillin-resistant Staphylococcus aureus subdural empyema. We performed in vitro experiments to determine if this novel mutation resulted in impaired NF-κB signaling. METHODS: IκBα phosphorylation experiments were performed using a Jurkat T cell line lacking endogenous NEMO expression that was transfected with vectors containing either the wild type or the patient's V146G mutation. The cells were stimulated with TNF-α to activate the NF-κB pathway. Phosphorylated IκBα was detected by immunoblotting with anti-phospho-IκBα antibodies. Peripheral blood mononuclear cells from the patient were stimulated with TNF-α or anti-CD3 and anti-CD28. Impaired IκBα degradation was detected using antibodies against the IκBα protein. RESULTS: While TNF-α stimulation resulted in IκBα phosphorylation in NEMO-deficient Jurkat cells reconstituted with wild-type NEMO, cell transfected with the V146G mutant exhibited a 75% reduction in phospho-IκBα. Peripheral blood mononuclear cells from the patient showed impaired degradation of IκBα after stimulation when compared with normal controls. CONCLUSIONS: The patient's V146G mutation results in impaired NF-κB activation in vitro. The mutation extends the known N-terminal boundary within the CC1 domain that produces an ectodermal dysplasia phenotype, and defines an infectious susceptibility previously unappreciated in ectodermal dysplasia with immunodeficiency (methicillin-resistant S. aureus subdural empyema), broadening the clinical spectrum associated with the disease.
Assuntos
Farmacorresistência Bacteriana , Empiema Subdural/genética , Quinase I-kappa B/metabolismo , Staphylococcus aureus/imunologia , Displasia Ectodérmica , Empiema Subdural/tratamento farmacológico , Empiema Subdural/metabolismo , Empiema Subdural/fisiopatologia , Humanos , Quinase I-kappa B/genética , Lactente , Células Jurkat , Masculino , Meticilina/uso terapêutico , Proteínas Mutantes/genética , Mutação de Sentido Incorreto/genética , NF-kappa B/genética , NF-kappa B/metabolismo , Transdução de Sinais , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , Ativação Transcricional/genética , Transgenes/genética , Fator de Necrose Tumoral alfa/imunologia , Fator de Necrose Tumoral alfa/metabolismoRESUMO
A 67-year-old man presented with a rare case of cavernous sinus thrombophlebitis (CST) caused by Porphyromonas gingivalis with abscess formation extending to the orbital cavity. Neuroimaging demonstrated a cystic lesion in the right cavernous sinus that was hyperintense on diffusion-weighted imaging. The patient was successfully treated with surgical drainage and antibiotic administration. CST is rare and often has a fulminant progression with high rates of morbidity and mortality. The differential diagnosis of cavernous sinus lesions should include CST. Early recognition and differentiation from other diseases with aggressive medical and possible surgical intervention are necessary to reduce mortality and long-term sequelae. Diffusion-weighted imaging is useful for the early recognition and differentiation of CST from other diseases.
Assuntos
Infecções por Bacteroidaceae/patologia , Trombose do Corpo Cavernoso/microbiologia , Trombose do Corpo Cavernoso/patologia , Empiema Subdural/microbiologia , Empiema Subdural/patologia , Porphyromonas gingivalis , Idoso , Antibacterianos/uso terapêutico , Infecções por Bacteroidaceae/complicações , Infecções por Bacteroidaceae/fisiopatologia , Seio Cavernoso/microbiologia , Seio Cavernoso/patologia , Seio Cavernoso/fisiopatologia , Trombose do Corpo Cavernoso/fisiopatologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Progressão da Doença , Drenagem/métodos , Empiema Subdural/fisiopatologia , Exoftalmia/etiologia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Órbita/patologia , Órbita/fisiopatologia , Órbita/cirurgia , Osteotomia/métodos , Dor/etiologia , Resultado do TratamentoRESUMO
Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.
Assuntos
Abscesso Encefálico/etiologia , Otite Média Supurativa/complicações , Adolescente , Adulto , Abscesso Encefálico/fisiopatologia , Abscesso Encefálico/terapia , Criança , Pré-Escolar , Colesteatoma/complicações , Doença Crônica , Doenças dos Nervos Cranianos , Empiema Subdural/etiologia , Empiema Subdural/fisiopatologia , Empiema Subdural/terapia , Abscesso Epidural/etiologia , Abscesso Epidural/fisiopatologia , Abscesso Epidural/terapia , Feminino , Febre , Cefaleia , Humanos , Masculino , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Otite Média Supurativa/fisiopatologia , Otite Média Supurativa/terapia , Estudos RetrospectivosRESUMO
In this retrospective case series, we describe the clinical features and microbiology of 16 previously healthy children with suppurative intracranial complications of sinusitis. Most cases were male adolescents who presented with vomiting in addition to typical sinusitis symptoms. Neurologic signs were often absent. Streptococcus milleri group organisms, along with anaerobes, were common pathogens.
Assuntos
Infecções Bacterianas/complicações , Abscesso Encefálico/etiologia , Empiema Subdural/etiologia , Sinusite/complicações , Adolescente , Bactérias Anaeróbias/isolamento & purificação , Infecções Bacterianas/microbiologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/fisiopatologia , Criança , Pré-Escolar , Empiema Subdural/diagnóstico por imagem , Empiema Subdural/microbiologia , Empiema Subdural/fisiopatologia , Feminino , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Sinusite/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificaçãoRESUMO
BACKGROUND: There are no pathognomonic presenting features of intracerebral abscesses. Their clinical features could be confused with those of a tumour or any other space occupying lesion. STUDY DESIGN: We analyzed the symptoms, predisposing factors, diagnostic modalities, prevalent causative microbes, management and outcome in 11 patients, for whom complete records were available and who were managed for confirmed intracerebral abscess in our Neurosurgical Unit from 1996 to 2000 and compared our findings with those from other series. RESULTS: In these patients focal neurological deficit was the most common clinical feature, trauma was the most predisposing event and Computerised Tomography (CT) Scanning remained the most dependable diagnostic tool. In our practice, burr hole drainage augmented with a minimum of 4 weeks intravenous antibiotics, was the most frequently used treatment modality. CONCLUSION: The outcome was satisfactory (ability to return to pre-morbid activities and duties, with no disabling neurological deficits) in 72.8% cases. There was one death. This modality remains an effective way of treating patients with intracebrebral abscess.
Assuntos
Abscesso Encefálico/diagnóstico , Empiema Subdural/diagnóstico , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Encéfalo/patologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/fisiopatologia , Abscesso Encefálico/terapia , Criança , Terapia Combinada , Diagnóstico Diferencial , Drenagem , Empiema Subdural/microbiologia , Empiema Subdural/fisiopatologia , Empiema Subdural/terapia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Resultado do TratamentoRESUMO
A cross-sectional study was conducted to predict the outcome in patients with subdural empyema, using initial and post-treatment CT scan brain parameters. Data collection was done on those children who were diagnosed to have subdural empyema by CT scan of the brain with contrast, who underwent burrhole evacuation, from February 2000 until April 2002. Numerous factors, such as coma or loss of unconsciousness at diagnosis, age, types of antibiotic, microbiology, extension of empyema, associated cerebral infarction and ventriculitis, were analyzed. Poor prognosis was associated with loss of consciousness, and hypodensity by CT scan at presentation (p < 0.005). Patients with an extensive subdural empyema will have a good outcome if they are treated early and aggressively with antibiotics and burrhole evacuation.
Assuntos
Empiema Subdural/diagnóstico por imagem , Empiema Subdural/cirurgia , Resultado do Tratamento , Antibacterianos/uso terapêutico , Sudeste Asiático , Meios de Contraste , Estudos Transversais , Drenagem , Empiema Subdural/tratamento farmacológico , Empiema Subdural/fisiopatologia , Feminino , Humanos , Lactente , Masculino , Procedimentos Neurocirúrgicos/métodos , Prognóstico , Radiografia , Tomografia Computadorizada de EmissãoRESUMO
OBJECTIVE: The Spiegelberg 3-PN intraparenchymal pressure sensor was clinically evaluated. DESCRIPTION OF INSTRUMENTATION: The Spiegelberg intraparenchymal pressure sensor is a low-cost device that uniquely performs regular automatic zeroing in situ throughout the measurement period. OPERATIVE TECHNIQUE: The Spiegelberg sensor was inserted in 87 patients who required intracranial pressure monitoring as part of their routine management. Complications were assessed by postoperative computed tomographic scanning and clinical investigation. The automated zeroing procedure was assessed after implantation of the sensor and during long-term measurement. In five patients, the "gold standard' of intraventricular pressure was measured simultaneously and compared with the intraparenchymal or subdural Spiegelberg 3-PN pressure. EXPERIENCE AND RESULTS: No complications associated with the Spiegelberg sensor were observed. The duration of monitoring ranged from 3 to 28 days (mean, 10 d). In 3 patients, technical problems occurred, and in 84 patients, the pressure measurement was successful, including the automatic zeroing procedures performed by the monitor after insertion and hourly thereafter. The absolute difference between the Spiegelberg reading and the intraventricular pressure was less than +/-3 mm Hg in 99.6% and less than +/-2 mm Hg in 91.3% of readings. An Altman-Bland bias plot revealed good agreement between the two methods, with an average bias of 0.5 mm Hg, but revealed a significant trend toward 10% lower Spiegelberg readings with increasing intracranial pressure of >25 mm Hg. There was no difference between intraparenchymal and subdural locations. CONCLUSION: The Spiegelberg 3-PN sensor was reliable and simple to use. It can be recommended for routine intraparenchymal and subdural pressure measurement at a considerably lower price compared with other tip transducers and has the unique advantage of automated zeroing in vivo.
Assuntos
Neoplasias Encefálicas/fisiopatologia , Traumatismos Craniocerebrais/fisiopatologia , Empiema Subdural/fisiopatologia , Hematoma Subdural/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/efeitos adversos , Monitorização Fisiológica/instrumentação , Complicações Pós-Operatórias , Hemorragia Subaracnóidea/fisiopatologia , Neoplasias Encefálicas/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Ventriculografia Cerebral , Traumatismos Craniocerebrais/diagnóstico por imagem , Craniotomia/efeitos adversos , Empiema Subdural/diagnóstico por imagem , Hematoma Subdural/diagnóstico por imagem , Humanos , Reprodutibilidade dos Testes , Hemorragia Subaracnóidea/diagnóstico por imagem , Espaço Subdural/diagnóstico por imagem , Espaço Subdural/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Transdutores de Pressão/efeitos adversosRESUMO
In subdural empyema (SDE), if the mass effect and vasogenic edema are not controlled, the brain can be fatally damaged. Massive SDE over the skull base often requires repeated surgical drainage for removal of accumulated pus. Intracranial pressure (ICP) management until obliteration of the empyema is important to the improvement of clinical outcome. An 18-year-old man was admitted to our center in a nearly comatose state and with a mild fever. CT scan showed massive SDE extending to the skull base and parafalx. ICP was measured with a pressure transducer through an intraventricle tube. Repeated surgical drainage was performed while ICP was controlled with barbiturate therapy. He was discharged with no neurological deficits. In patients with an extensive SDE over the cerebral hemisphere, ICP control with barbiturate therapy may enhance the therapeutic effect of surgical drainage.
Assuntos
Barbitúricos/uso terapêutico , Empiema Subdural/terapia , Pressão Intracraniana , Adolescente , Encéfalo/diagnóstico por imagem , Coma , Drenagem , Empiema Subdural/diagnóstico , Empiema Subdural/fisiopatologia , Febre , Humanos , Masculino , Monitorização Fisiológica , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Previous studies have demonstrated that rhinogenic subdural empyema (SDE) generally has a good prognosis. Most patients are admitted with an altered level of consciousness or significant neurological deficit, but eventually have a good outcome. It is well known that intra-operative brain swelling may occur with subdural empyema. OBJECTIVE: To define cerebral blood flow (CBF) dynamics and determine the role of cerebral hyperaemia, if any, in intracranial SDE. METHODS: CBF dynamics were assessed in five patients (mean age 13.2 +/- 2.2 years) with unilateral rhinogenic convexity SDE documented on computer tomography (CT). Regional cortical blood flow (rCBF) was measured using a thermo-coupled sensor placed on the cortex at the time of surgery. Dynamic CT scans were performed to assess cerebral blood volume (CBV) quantitatively, while transcranial Doppler ultrasonography (TCD) was used to measure cerebral blood flow velocities (CBF velocities) both pre- and post-operatively for 21 days. The opposite 'normal' hemisphere served as a control for each patient. RESULTS: Post-operative rCBF and CBF velocities in the pathological hemisphere progressively increased to plateau at 96 hours. Cerebral blood volume was increased bilaterally, but to a greater extent in the pathological hemisphere and more so in grey than white matter. These haemodynamic changes, though clinically significant did not reach statistical significance (p>0.05). CONCLUSION: Our results suggest that the accompanying brain swelling in rhinogenic SDE is a complex event, with reactive cerebral hyperaemia possibly playing neuroprotective role. Furthermore, unilateral convexity empyema causes bilateral cerebral haemodynamic changes. Future studies are necessary to define the aetiology of brain swelling in intracranial SDE.
Assuntos
Circulação Cerebrovascular/fisiologia , Empiema Subdural/complicações , Empiema Subdural/fisiopatologia , Encefalite/etiologia , Encefalite/fisiopatologia , Hiperemia/complicações , Hiperemia/fisiopatologia , Doenças Nasais/complicações , Doenças Nasais/fisiopatologia , Adolescente , Criança , Feminino , Humanos , MasculinoAssuntos
Bacteriemia/complicações , Maus-Tratos Infantis , Empiema Subdural/complicações , Hematoma Subdural/complicações , Infecções Estafilocócicas/complicações , Bacteriemia/diagnóstico , Bacteriemia/fisiopatologia , Diagnóstico Diferencial , Empiema Subdural/diagnóstico , Empiema Subdural/fisiopatologia , Hematoma Subdural/diagnóstico , Hematoma Subdural/fisiopatologia , Humanos , Lactente , Masculino , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/fisiopatologiaRESUMO
El empiema subdural es una complicación rara de las infecciones por Salmonela. Se informa de un lactante con desnutrición grave y síndrome de Down, quien cursó con gastroenteritis aguda y bacteremia por Salmonella anteritidis que después de ser tratado con antibióticos fue dado de alta con aparente mejoría clínica. Un mes después desarrolló un síndrome febril y dificultad respiratoria, mostrando la fontanela anterior abombada; se agregaron crisis convulsivas focalizadas y deterioro cefalocaudal. El estudio microbiológico informó la presencia de bacilos gram negativos y se cultivó Salmonela enteritidis, sensible a cefotaxima. Fue tratado durante tres semanas con antibióticos para luego ser dado de alta
Assuntos
Lactente , Humanos , Masculino , Salmonella enteritidis/isolamento & purificação , Empiema Subdural/diagnóstico , Empiema Subdural/fisiopatologia , Empiema Subdural/tratamento farmacológico , Cefotaxima/uso terapêutico , Ampicilina/uso terapêutico , Metronidazol/uso terapêuticoRESUMO
Brain abscess and subdural empyema are serious infections which can be metastasis of chronic suppurative diseases (bronchectasia, lung orabdominal abscess) or of congenital cardiopathy, but they are more frequently seen in healthy adults suffering from chronic sinusitis or otitis. Brain CT scan with contrast media injection is the best tool for diagnosis and follow-up. It has transformed the prognosis of brain abscesses. Anaerobic oropharyngeal microflora is the main source of bacteria responsible for suppurative brain diseases. Surgical treatment consist of aspiration or, rarely now, of excision of the lesion. Medical treatment alone can be successfull in selected cases, provided patients are closely monitored and antibiotics with good penetration into the brain parenchyma are used
Assuntos
Humanos , Abscesso Encefálico/fisiopatologia , Empiema Subdural/fisiopatologia , Antibacterianos/farmacocinética , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgiaAssuntos
Recém-Nascido , Lactente , Humanos , Ventrículos Cerebrais , Empiema Subdural/diagnóstico , Empiema Subdural/epidemiologia , Empiema Subdural/fisiopatologia , Empiema Subdural/terapia , Encefalite/diagnóstico , Encefalite/epidemiologia , Encefalite/fisiopatologia , Encefalite/terapia , Empiema Subdural/etiologia , Encefalite/líquido cefalorraquidiano , Encefalite/etiologia , Encefalite/mortalidade , Meningite/complicações , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Between the years 1963 to 1982, 84 consecutive cases of intracranial complications of ear disease in pediatric patients were diagnosed and treated at the North Carolina Baptist Hospital. This group consisted of 65 patients with otitic meningitis, four with otitic brain abscess, four with otitic hydrocephalus, three with lateral sinus thrombosis, three with otitic subdural empyemas, and five with an otitic subdural effusion of fluid. The advent of antibiotics has drastically altered the natural history of middle ear infections. We present these 84 cases to review diagnostic problems and therapeutic options, and to offer a plea for continued awareness of the middle ear as a potential source of central nervous system complications.
Assuntos
Otopatias/complicações , Empiema Subdural/etiologia , Meningite/etiologia , Otite Média/complicações , Derrame Subdural/etiologia , Doença Aguda , Adolescente , Adulto , Abscesso Encefálico/etiologia , Abscesso Encefálico/fisiopatologia , Encefalopatias/etiologia , Encefalopatias/fisiopatologia , Criança , Pré-Escolar , Doença Crônica , Otopatias/fisiopatologia , Otopatias/terapia , Empiema Subdural/fisiopatologia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Lactente , Recém-Nascido , Embolia e Trombose Intracraniana/etiologia , Embolia e Trombose Intracraniana/fisiopatologia , Otite Média/fisiopatologia , Otite Média/terapia , Derrame Subdural/fisiopatologiaRESUMO
Subdural empyema and cranial epidural abscess are life-threatening infections that require a combined medical and surgical approach for proper management. The pathophysiology, clinical presentation, diagnosis, and treatment of these conditions are discussed.