頭部受傷後肺炎雙球菌腦膜炎併發大腦內血腫感染－病例報告

本文報告一例頭部外傷後併發肺炎雙球菌腦膜炎及菌血症的2歲病童，雖經盤尼西林治療後仍然續發大腦內血腫被感染的病例。在本病例中顱內感染血腫續發於腦膜炎可由病史、臨床症狀及一系列腦部電腦斷層攝影所診斷，在使用盤尼西林治療肺炎雙球菌腦膜炎後，外傷性大腦內血腫仍無法避免於被感染而形成血腫膿瘍，最後經由開顱術清除血腫膿瘍再加上高劑量盤尼林治療四週後才得痊癒。由於頭部受傷後併發腦膜炎的兒科病例並不多見，而同時又合併有大腦內血腫感染的更是罕見，本文就此兩點提出報告並予以文獻回顧討論。

關鍵字

創傷後腦膜炎；感染性大腦內血腫；肺炎雙球菌腦膜炎

並列摘要

An intracerebral hematoma in the left fornto-temporo- parietal area caused by uncomplicated head trauma was found to be infected two weeks after parenteral penicillin treatment of pneumococcal meningitis. When a computerized tomographic scan was taken for determining the cause of pyogenic meningitis, the intracranial hematoma was found accidentally. Tracing his past history, this 2-year-old boy got an uncomplicated frontal head trauma from a one-foot high chair five days before admission. He had been well until 3 days later when fever developed. In spite of aggressive medical therapy, high fever still persisted. A repeat brain CT scan was followed 14 days later. The preexisting hematoma didn't resolve but became larger in size and also appeared lobulated with ring shape of enhancement. Craniotomy was performed, an abscess was encountered and there embeded a hematoma about 3 cm in diameter which located in the central cavity of the abscess. This patient got well after surgical intervention and another 4 week's parenteral penicillin treatment. To our knowledge, there were no similiar occurrances before regarding a post-traumatic infected intracerebral hematoma complicated with meningitis in spite of high dose of penicillin treatment. Post-traumatic menigitis is a rare complication of head trauma in children and can occur with no signs of dural tear or basal fracture. The rarity of a intracerebral hematoma becoming infected is also mentioned.

並列關鍵字

Post-traumatic meningitis ； infected intracerebral hematoma ； pneumococcal meningitis

國際替代計量

頭部受傷後肺炎雙球菌腦膜炎併發大腦內血腫感染－病例報告

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