Neurological Deficits as an Unusual Presentation of a Retropharyngeal Abscess

隨著抗生素的進步，咽後膿瘍的發生率已有顯著的下降，但是若延遲診斷及治療仍會產生嚴重甚至致命的併發症，如內頸靜脈栓塞、呼吸道阻塞、縱隔腔炎及敗血症，除此之外還可能發生相當罕見的頸椎骨隨炎和脊椎硬膜上膿瘍。咽後膿瘍的病人若出現神經學異常就要懷疑是否有侵犯頸椎。文獻上僅有少數咽後膿瘍併發頸椎骨隨炎和脊椎硬膜上膿瘍的病例報告，而且從未提及咀嚼檳榔與咽後膿瘍的相關性。我們報告一個咽後膿瘍的病例，病患主訴喉嚨痛及吞嚥困難將近一個月，但病患有咀嚼檳榔而導致口咽黏膜下纖維化的病史，因此被診斷為慢性咽喉炎，最後出現急性尿滯留併兩側下肢無力。經過立即外科手術減壓及積極的抗生素治療，病患完全康復。

關鍵字

咽後膿瘍；神經學異常

並列摘要

The incidence of retropharyngeal abscesses (RPAs) has been greatly reduced by progress in antibiotics. However, serious and even lethal complications, such as internal jugular vein thrombosis, airway obstruction, mediastinitis, and sepsis, continue to occur when both diagnosis and treatment are delayed. In addition to those terrible complications, cervical vertebral osteomyelitis (VOM) and a spinal epidural abscess (SEA) may occur, although they are extremely rare. The intraspinal involvement of an RPA should be suspected if a patient has neurologic deficits. Only a small number of RPAs complicated by VOM and an SEA have been reported in the literature. Furthermore, to our best knowledge, the literature has mentioned no clinical association between an RPA and betel nut chewing. We present the occurrence of an RPA in a case who chewed betel nut, a common habit in the western Pacific and southern part of Asia. Our patient presented with rapid progression of urinary retention with weakness over the bilateral lower limbs after a period of suffering from a sore throat and dysphagia, which were misdiagnosed as pharyngitis and chronic infection of the oropharynx due to oral submucous fibrosis that had resulted from betel nut chewing. Immediate surgical decompression and aggressive antibiotics treatment were given, after which the patient completely recovered.

並列關鍵字

retropharyngeal abscess ； neurological deficits

國際替代計量

Neurological Deficits as an Unusual Presentation of a Retropharyngeal Abscess

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