Spinal Epidural Abscess-A Case Report

隨著抗生素的使用，中樞神經系統的感染，包括硬腦膜內外膿腫及大腦內膿腫，脊椎硬腦膿腫，已有減少的趨勢。尤其是脊椎硬腦膜外膿腫幾乎很少見。以至於很多醫師不知道怎樣診斷或甚至於不知道怎樣治療此病。由於核磁共振攝影的使用，脊椎硬腦膜外膿腫可以很清楚的診斷出來。但是最重要的是臨床醫師對患者的警覺性。這包括家庭醫學科醫師，神經內外科醫師，放射線科醫師，骨科醫師，感染科醫師間的合作。一般脊椎硬腦膜外膿腫的發生，可能是由於外傷，脊椎手術或心內膜炎或局部的感染，或放置脊椎導管時，尿道炎，腎盂炎，少數是由腫瘤侵犯後併發細菌的感染。患者發生脊椎硬腦膜外膿腫時，一般會有腰部疼痛，發燒，白血球上升，神經上的症狀包括下肢無力或癱瘓，尿失禁或糞便失禁。但有時亦不會產生上述症狀，此需要比較高的警覺性。一般發生上述症狀時，即使接受手術及抗生素治療，其預後亦不甚理想。本文提出一例發生腎盂炎後併發慢性脊椎硬腦膜外膿腫的患者，接受脊椎手術後，下肢無力有顯著改善現象。僅提出來作為參考。

關鍵字

無資料

並列摘要

Despite modern medical advances, the morbidity and mortality rates associated with spinal epiclural abscess remain significant, and the diagnosis is elusive. The incidence of spinal epidurai abscess is approximately one to two cases per 10000 among all patients admitted to hospitals(1). The symptoms of spinal epidural abscess are varied but include lower back pain, fever, local tenderness and neurological deficit especially in such high risk groups as patients with diabetes, Intravenous drug abuse, chronic renal failure, alcoholism, liver disease and immunocompromization. Accumulation of data Is difficult in that many physicians will never see a case during their careers2’. Herein, we present a case with lower back pain associated with both lower legs weakness. His abdomenon CT revealed retroperitonium and right perirenal abscess. External drainage as well as antibiotic treatment was done immediately. However, the lower legs weakness became severe and a lumbar spine MRI revealed T11-L4 epidural abscesses and L2-3 Intervertebral space pus formation. Then, the patient was transfered to our Neurosurgical Ward for further treatment. His postoperative condition improved in both lower legs. This case report is to enhance the recognition and treatment of spinal epidural abscess, a rare affliction.

並列關鍵字

epidural abscess ； intervertebral abscess ； erythrocyte sedimentation rate

國際替代計量

Spinal Epidural Abscess-A Case Report

全文下載

主題瀏覽