新生儿细菌性脑膜炎并后颅窝硬膜下积脓1例

Case report of bacterial meningitis complicated with posterior fossa subdural empyema in a newborn

对2019年12月四川大学华西第二医院收治的1例新生儿细菌性脑膜炎并后颅窝硬膜下积脓患儿的临床资料进行回顾性分析。患儿,男,3 d,因"皮肤黄染伴奶量下降1 d"入院。入院检查:C反应蛋白升高。脑脊液有核细胞计数明显升高,以中性粒细胞为主,可见脓细胞,蛋白含量升高,糖含量降低,脑脊液及血培养均提示大肠埃希菌。头部增强磁共振提示双侧枕部小脑外间隙见大片异常信号,T1加权像呈稍低、稍高混杂信号,T2加权像呈高信号,增强后可见边缘强化。经过美罗培南联合头孢他啶抗感染治疗6周,患儿复查脑脊液指标恢复正常,后颅窝硬膜下积脓基本消退。细菌性脑膜炎并发后颅窝硬膜下积脓临床罕见,属于中枢神经系统危重症。由于临床表现缺乏特异性、早期影像学征象不突出,容易漏诊和误诊。该病需要进行足够疗程的抗感染治疗;如果抗生素治疗效果不佳,应行外科积脓清除手术。

The clinical data of a case of neonatal bacterial meningitis complicated with posterior fossa subdural empyema in the West China Second University Hospital in December 2019 were retrospectively analyzed.The 3-day-old male newborn was admitted for jaundice with decreased intake for 1 day.Examinations on admission showed increased C-reactive protein.The count of karyocytes in cerebrospinal fluid(CSF)significantly increased,which were mainly neutrophils,and pyocytes could be found.The protein content in CSF increased,while that of glucose decreased.Both CSF culture and blood culture detected the presence of Escherichia coli.Enhanced magnetic resonance imaging(MRI)of the head indicated large abnormal signals in bilateral occipital extra-cerebellar spaces.T1-weighted images presented mixed low and high signals,and T2-weighted images presented high signals,and marginal enhancement was observed after enhancement.After 6 weeks of antibiotic treatment using Meropenem combined with Ceftazidime,the CSF index of the newborn patient returned to normal,and the subdural empyema of the posterior fossae subsided.Bacterial meningitis complicated with subdural empyema of posterior fossa is a rare and critical disease of the central nervous system.It is easily misdiagnosed due to the atypical clinical manifestations and early imaging features.The disease requires an adequate course of anti-infective treatment.Surgical removal of the empyema should be performed if the anti-infective treatment is unresponsive.