脑内小脓肿的诊断和治疗方法选择

Diagnosis and treatment procedure selection of small cerebral abscess

目的 探讨脑内小脓肿的诊断和最佳治疗方法。方法 收集近 5年来诊治的 5 2例脑内直径 2 .0cm以下小脓肿资料 ,对病史特征、CT及MRI表现和治疗结果进行回顾性分析。结果 4 1例无感染史 ,4 5例以癫痫发作起病并为主要症状 ,通常没有局部神经受损体征。单纯抗菌疗法治愈 5 0例 ,手术治疗 2例 ,其中 1例术后留有轻度神经功能障碍。结论 脑内小脓肿的主要临床特征是癫痫发作 ,CT和MRI是诊断的关键手段 ,治疗上应首选非手术疗法 ,仅个别对抗菌疗法不敏感者才可考虑手术治疗。

Objective To explore the diagnosis and the best treatment procedures of small cerebral abscess. Methods 35 cases of small cerebral abscesses with the diameter under 2.0 cm were collected since 1992.The history of illness,manifestation of CT and MRI,the results of treatment were analysed retrospectively.Results 24 cases without history of infection. In 29 cases,epileptic seizures were the initial and main symptoms.The local neurologic signs were usually absent.33 cases were cured only by antibiotic therapy.The other two cases were treated by operation,one had slight disturbance of local neurologic function postoperatively.Conclusion The epileptic seizure was the main clinical character of small cerebral abscessess.CT and MRI plays the key role in diagnosis.Non-operative method should be selected first. Only when these cerebral abscesses have no response to antibiotic therapy,surgical operation can be considered.