硬膜下积脓的临床特点及治疗分析

Clinical features and therapy of subdural empyema

目的探讨硬膜下积脓(Subdural empyema,SDE)的临床特点,为临床治疗提供借鉴。方法回顾性分析本科保守治疗的硬膜下积脓病例1例,并对已有文献报道进行综述,总结其临床、影像学表现及治疗。结果文献报道共50例患者,48例外科手术治疗,2例内科保守治疗。SDE起病急,主要临床表现为大脑镰综合征、抽搐,意识障碍。头磁共振表现:大脑镰及小脑幕下积脓呈长T1,长T2信号,FLAIR呈高信号,DWI呈高信号,积脓周围脑膜强化。治疗上主要以外科手术为主,少数病例通过合理的抗菌药物治疗也可好转。结论镰幕硬膜下积脓的临床特点是大脑镰综合征和镰幕下积脓;以外科治疗为主,内科保守治疗也是一种可行的治疗方法。

Objective To investigate the clinical features of subdural empyema and provide reference for clinical therapy. Methods The clinical data of a SDE case treated conservatively in our hospital,the clinical,imaging features and treatment of 50 SDE cases in articles were analyzed retrospectively. Results There were 50 SDE cases reported with 48 cases treated with surgery and 2 cases treated conservatively. The onset of SDE was acute. The main clinical manifestations： cerebral falx syndrome,focal seizures,consciousness. M RI manifestations： long T1 and long T2 signals; high DWI and FLAIR signal; meninges around the empyema were enhanced with contrast. Surgery is the main treatment,followed by conservative treatment. Conclusion Falcotentorial subdural empyema is rare,and clinical features included cerebral falx syndrome and falcotentorial subdural empyema. Though surgery is the main treatment measure,conservative treatment is feasible.