뇌경막하 농양에 대한 임상고찰
Clinical Review of Cerebral Subdural Empyema
소속 상세정보
김상철/Sang Cheol Kim
강재규/고영관/도종웅/Jae Kyu Kang/Koh Young Kwan/Jong Oung Do
KMID : 0359819990280091337
Abstract
결론
경막하 농양은 임상적으로 급속히 진행하므로 조기진단과 적절한 치료를 하지 못했을 경
우 치명적일 수 있다. 최근 진단 방법의 발달 및 항생제의 발달로 감소하였다고는 하지만
아직도 10∼20%의 높은 사망률을 기록하고 있다. 본 연구에서는 진단과 동시에 응급 배농
술을 시행하여 8례 (80%)에서 좋은 예후를 보였다. 사망한 환자는 없었으나, 수술후 2례
(20%)에서 심한 중증무능력 상태를 보였는데 이들 환자는 내원당시 의식이 나빴으며, 증상
발현 후 진단과 수술 및 항생제투여가 지연되었다. 뇌경막하 농양에서 무엇보다도 중요한
것은 조기진단과 개두술 및 적절한 항생제 요법이다.
#초록#
Objective : The purpose of this study was to review our experience with subdural
empyema. Clinical presentation, methods of diagnosis, results of microbiological tests,
typos of therapy, and outcome of patients are presented and compared with previous
reports
Methods : The study consists of 10 patients With subdural empyema treated from
January 1888 to December 1997. Clinical accords and radiologic studies were reviewed
retrospectively. The patient population consisted of 8 men and 2 women, whose ages
ranged from 12 to 65 years(mean 49.1 years). Diagnosis of subdural empyema was
confirmed with contrast-enhanced CT scanning or Gadolinium-enhanced MR imaging.
Seven patients received surgical treatments and three patients were treated with a
multiple antibiotics only.
Result : The subdural empyema have been found to occur most commonly after
paranasal sinusitis and postoperative infection in four cases respectively, otitis media and
mastoiditis in one case respectively. The organism were found to be staphylococci in
three cases, streptococci in two cases, anaerobic streptococci in one case, sterile in one
case, and unknown in three cases. Relative frequency of signs and symptoms revealed
fever in eight cases, headache in seven cases, vomiting in five cases, hemiparesis in
three cases. and epilepsy in two cases. The outcome was revealed good in eight cases,
poor in two cases.
Conclusion : Although subdural empyema is considered a bare condition, it constitutes
between 19 and 23 per cent of all intracranial infectin. It usually presents as a fulminant
clinical picture and rapid neurological deterioration. In this sense, it constitutes a true
neurosurgical emergency. Diagnosis of subdural empyema is best made by either CT
with contrast or by MRI. Both of these tests are also helpful in establishing the
presence or absence of sinusitis. Subesquently, surgery along with antibiotics help to
lower mortality rate Antibiotics therapy should be selected according to final culture
results and continued for 4 to 5 weeks. The general consensus is in favour of early
drainage to reduce the mortality and clinical deterioration. In our study. the overall
mortality rate was 0%, and 20% of patients had neurological deficiencies at the time of
discharge from the hospital. It is vary important for clinician to detect this condition
early to keep low mortality and morbidity.
키워드
Subdural empyema; Brain CT; MRI; Early drainage;
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