儿童乳突炎继发静脉窦血栓伴脑脓肿1例并文献复习

Venous sinus thrombosis with brain abscess secondary to mastoiditis in children(a case report and literature review)

目的 儿童乳突炎继发静脉窦血栓伴脑脓肿的临床、影像学、诊疗方法及预后。方法 回顾性分析1例儿童乳突炎继发静脉窦血栓伴脑脓肿患者的临床资料,并复习相关文献。结果 患儿男,12岁,临床表现为发热、头痛、呕吐及左侧肢体无力,考虑乳突炎引起的多发脑脓肿伴静脉窦血栓。行右额钻孔硬膜下脓肿引流,术后脓液微生物培养提示金黄色葡萄球菌,采用万古霉素+美罗培南+甲硝唑注射液治疗3周余后好转出院,出院后口服利奈唑胺抗感染治疗2个月后恢复良好。结论 感染性的静脉窦血栓极为少见,儿童相较成人多,近半数近期有感染。诊断和治疗需结合病史,影像学特点及微生物检验来判断,可考虑手术并积极抗感染治疗。

Objective To investigate the clinical data,imaging,diagnosis,treatment and prognosis of venous sinus thrombosis with brain abscess secondary to mastoiditis in children.Methods The clinical data of a child with venous sinus thrombosis secondary to mastoiditis and brain abscess were analyzed retrospectively,and the relevant literature were reviewed.Results The patient was a 12-year-old boy with fever,headache,vomiting and weakness of the left limb.Multiple brain abscesses with venous sinus thrombosis caused by mastoiditis were considered.Drainage of subdural abscess was performed through right frontal burr hole.The microbial culture of pus after operation suggested Staphylococcus aureus.It improved after more than 3 weeks of treatment with vancomycin+meropenem+metronidazole,and it recovered well after 2 months of anti infection treatment with linezolid.Conclusions Infective venous sinus thrombosis is very rare,and more in children than in adults.Nearly half of them have recent infection.Diagnosis and treatment should be judged in combination with medical history,imaging characteristics and microbiological test.Surgery and active anti infection treatment can be considered.