Infantile Chronic Subdural Hematoma Infected by Escherichia Coli -Case Report
Infantile Chronic Subdural Hematoma Infected by Escherichia Coli -Case Report
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DOI：
10.2176/nmc.50.482
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发表时间：
2010-06-01
影响因子：
1.9
通讯作者：
Ito, Masanori
中科院分区：
文献类型：
--
作者：
Iimura, Yasushi;Tsutsumi, Satoshi;Ito, Masanori
一个6个月大的男孩提出了一个罕见的病例感染硬膜下出血表现为持续发烧和局灶性癫痫发作。这名男孩身体健康，无其他病史。体格检查未见神经损伤，外观完整，囟门柔软。父母否认最近有头部外伤或摇晃伤。血液检查正常，白细胞19200/ μ l， c反应蛋白6.7 mg/dl。鼻拭子、尿液、粪便和静脉血样本的细菌培养均为阴性。脑脊液检查正常。颅脑计算机断层扫描显示右侧额颞区有广泛的硬膜下积液。磁共振成像显示病变T1-低信号，t2 -高信号，外膜强化。患者行钻孔引流术，发现硬膜下血肿包裹在厚外膜内，并与脓液物质混合。脓液培养鉴定出大肠杆菌。患者接受抗生素治疗8周，感染完全消除。我们假设先前存在的硬膜下血肿是在轻微头部创伤后形成的，随后是大肠杆菌的血源性感染。感染硬膜下血肿是可能的婴儿表现为硬膜下出血，临床症状为菌血症。
A 6-month-old boy presented with a rare case of infected subdural hemorrhage manifesting as sustained fever and focal seizure. The boy had been well without contributory medical history. Physical examination found no neurological impairment with intact superficial appearance and soft fontanels. The parents denied recent head trauma or shaking injury. Blood examination was normal except for white blood cell count of 19200/mu l and C-reactive protein level of 6.7 mg/dl. Bacterial culture of nasal swab, urine, stool, and venous blood samples was negative. Cerebrospinal fluid examination showed normal findings. Cranial computed tomography revealed an expansive subdural fluid collection in the right frontotemporal region. Magnetic resonance imaging showed the lesion as hypointense on T1- and hyperintense on T2-weighted images with intense enhancement of the outer membrane. The patient underwent burr-hole drainage, which identified the subdural hematoma encapsulated in a thick outer membrane and intermingled with pus material. Culture of the pus identified Escherichia coli. The patient received antibiotic therapy for 8 weeks that resulted in complete resolution of the infection. We assumed that preexisting subdural hematoma formed after minor head trauma was followed by hematogenous infection by E. coli. Infected subdural hematoma is possible in infants presenting with subdural hemorrhage with clinical symptoms of bacteremia.