小兒急性鼻竇炎併發硬腦膜下膿瘍-病例報告

Acute Sinusitis Complicated by Subdural Abscess in a Child-Case Report

黃麒銓(Chi-Chiuan Huang) ； 歐俊巖(Chun-Yen Ou)

《中華民國耳鼻喉科醫學雜誌》 36卷4期 (2001/06) Pp. 239-243

https://doi.org/10.6286/2001.36.4.239

摘要

在鼻竇炎的併發症中，最常見的是侵犯眼球以及眼眶四周。當今由於抗生素效能增強以及被廣泛的使用，因鼻竇炎引起的顱內併發症已大為少見。然而因為臨床上的症狀以頭痛、發燒、意識狀態改變為主，同時病人多半沒有明顯的鼻部症狀，因此容易被忽略，導致延誤治療，提高了致病率及死亡率。本例病患為1名9歲肥胖男童，因發燒、頭痛持續4天而被送至本院。入院檢查時發現該男童意識狀態改變、頸部僵硬並有吐現象，加上血液檢查呈現嗜中性白血球以及C型應蛋白(CRP)明顯上升，疑似為顱內感染。經過腰椎穿刺以及頭部電腦斷層攝影檢查，發現為右側上頜竇鼻竇炎合併左側額葉區以及兩側半球間池(interhemispheric cistern)硬腦膜下膿瘍，於是病患接受鼻竇內視鏡手術以及顱部手術排膿治療。經過8週的抗生素治療，術後3個月以磁振造影追蹤，已無硬腦膜下膿瘍之現象。由此病例可知，對於懷疑有急性顱內感染的小兒病患，鼻竇炎必須列入鑑別診斷。早期影像學檢查為診斷的利器，特別是磁振造影比電腦斷層攝影會有較高的敏感度。有了早期及時的診斷，配合排膿手術適合的抗生素治療，才能有效降低死亡率並減少後遺症。(中耳醫誌2001；36; 239-243)

關鍵字

小兒鼻竇炎 ； 併發症 ； 顱內感染

並列摘要

Complications and local extension of paranasal sinus infections typically involve the orbit and periorbital areas. With the advances in and widespread use of antibiotics, intracranial sinusitis complications are rarely seen nowadays. The most frequent symptoms and signs at presentation are fever, headache, and altered consciousness, but not necessarily with nasal symptoms. Accordingly, intracranial complications are easily missed and can result in high mortality and morbidity. An obese, 9-year-ole boy was referred to our hospital with a four day history of fever and headache. On examination, altered consciousness, neck stiffness, and vomiting were apparent. Hematological analysis found elevated neutrophil counts and an increase in C-reactive protein (CRP). Intracranial infection was therefore suspected. A lumbar puncture and CT scan were performed, and right maxillary sinusitis with a subdural abscess over the left frontal lobe and interhemispheric cistern were identified. He underwent endoscopic sinus surgery and intracranial surgery for drainage. Postoperatively, he received an eight-week course of intra-venous antibiotics. Follow up magnetic resonance imaging three months later found no remnants of the subdural abscess. With or without nasal symptoms, complicated sinusitis must be included in the differential diagnosis in pediatric patients with suspected acute intracranial infections. Early imaging is a powerful diagnostic tool, and magnetic resonance imaging has a higher sensitivity than CT. Early diagnosis followed by surgical drainage and appropriate antibiotics treatment is the only effective means by which mortality and complications can be reduced.

並列關鍵字

pediatric sinusitis ； complication ； intracranial infection