严重的晚发性脑膜炎发生在基础骨头骨折后一年,没有脑脊液泄漏:一个病例报告
Aya Ozaki1, Takamitsu Iwata1,2, Eisaku Terada1
1Department of Neurosurgery, Sakai City Medical Center, Sakai, JPN.
Cureus
|January 7, 2025
概括
晚期细菌性脑膜炎可能发生在头骨底部骨折多年后,即使没有脑脊液 (CSF) 泄漏. 长期损伤的手术修复对于管理这些严重感染至关重要.
科学领域:
- 神经外科 神经外科
- 传染性疾病 传染性疾病
- 创伤外科 手术 创伤外科
背景情况:
- 创伤性脑脊液 (CSF) 从头骨底部骨折泄漏增加了细菌性脑膜炎的风险,这是一种严重的疾病,在成年人中具有高死亡率和严重的神经后果.
- 虽然大多数CSF泄漏在三个月内自发地消失,但延迟发作的脑膜炎会带来重大的临床挑战.
- 这一案例凸显了延迟脑膜炎的可能性,即使没有明显的脑脊髓液泄漏.
研究的目的:
- 报告一种罕见的严重细菌性脑膜炎病例,该病例发生在前额头骨基骨折发生一年后,并没有初始的CSF泄漏.
- 强调在患有头骨底部创伤和骨缺陷的患者中考虑隐性持续损伤的重要性.
- 讨论骨基骨折后延迟性脑膜炎的治疗方法,包括外科持续性修复.
主要方法:
- 一个68岁的男性病例报告,有前列骨基骨折史,表现为脑膜炎症状.
- 诊断成像 (CT/MRI) 以确定腹腔炎和形成.
- 细菌培养物识别 * 肺炎菌 Streptococcus * 作为致病原体.
- 治疗包括初始抗生素,外科持续修复与骨周脚片,以及随后的水头的管理.
主要成果:
- 患者在骨折后一年出现了严重的细菌性脑膜炎和心室内,尽管最初没有CSF泄漏.
- 图像检查显示,骨折部位附近出现了新的,这表明细菌通过隐藏的持续损伤进入了骨.
- 手术后修复和抗生素治疗导致的解决.
- 患者需要进一步治疗后脑膜炎脑炎.
结论:
- 头骨底部骨折,特别是具有骨缺陷的骨折,即使没有明显的CSF泄漏,也会构成延迟脑膜炎的长期风险.
- 在患有头骨底部创伤的患者中应该怀疑隐藏的持续损伤.
- 在底创伤后发生的脑膜炎中,应考虑与抗生素一起进行外科持续修复,无论脑脊髓液是否存在泄漏,以改善结果.
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