Prospective Neurosonographic Study in Infantile Purulent Meningitis

化膿性腦膜炎的前瞻性神經超音波學研究

沈淵瑤(Ein-Yiao Shen) ； 蔡宗佑(Chung-Yau Tsai) ； 黃棣棟(Tai-Tong Wong)

《Acta Paediatrica Sinica》 39卷3期 (1998/06) Pp. 180-185

https://doi.org/10.7097/APS.199806.0180

摘要

嬰幼兒期的細菌性腦膜炎常肇成很高的死亡率及後遺症，此化膿症腦膜炎可併發腦室炎，硬腦膜下蓄膿、腦膿瘍、水腦、靜脈栓塞、動脈血管炎及腦梗塞等，以神經影像檢查來早期偵測這些併發的病變，並佐以必要的外科治療，可降低這些病變對腦細胞的破壞並減少後遺症。本研究以前瞻性的神經超音波檢查，對經診斷為化膿性腦膜炎的嬰幼兒，自第一天、第二天、第三天、第五天、第七天、第十天、第十四天、第二十一天、第二十八天、二個月、四個月及六個月，每一病例進行十二次規則性觀察研究，早期發現包括腦水腫八例，硬腦膜下積水四例，腦室炎及腦室擴大五例，腦室膜下囊腫一例，週腦室出血一例及腦組織迴音加強七例。在追蹤時期，如果發現有進行性水腦或硬腦膜下積膿而有壓迫現象，則與神經外科醫師會診，進行必要的外科治療，吾人發現，以此超音波之檢查，合併適當的時期外科治療，對病人的預後助益很大。

關鍵字

神經超音波 ； 化膿性腦膜炎 ； 幼兒 ； 嬰兒

並列摘要

Fourteen infants or neonates with purulent meningitis underwent prospective brain sonography follow-up for early detection of intracranial complications. Most patients had 12 scans during a 6 month period. The children’s ages ranged from 5 days to 11 months. Early surgical intervention is suggested in progressive ventricular dilatation or severe subdural fluid collection. One patient with hydrocephalus had ventriculoperitoneal shunting. Three patients developed subdural empyema. One had subdural external drainage; and repeat subdural tappings were done in the other two. All these patients recovered without obvious neurologic sequelae. Two other patients developed ventricular dilatation one month after the onset of meningitis. Hydrocephalus ex vacuo was suspected and there were no indications for shunt surgery. These latter two cases had developed mild psychomotor retardation on their last follow-up. This primitive observation suggests that early detection with prospective, sequential sonography follow-up and appropriate surgical intervention for hydrocephalus or subdural fluid collection may lessen the neurologic sequelae in infantile and neonatal purulent meningitis.

並列關鍵字

Neurosonography ； purulent meningitis ； infant ； newborn