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首页> 外文期刊>Neurosurgery >Prodromal signs and clinical factors influencing outcome in patients with intraventricular rupture of purulent brain abscess.
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Prodromal signs and clinical factors influencing outcome in patients with intraventricular rupture of purulent brain abscess.

机译：脑脓肿性脑室内破裂患者的前驱体征和影响预后的临床因素。

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OBJECTIVE: To elucidate prodromal signs and clinical factors influencing the prognosis in patients with intraventricular rupture of brain abscess (IVROBA) to prevent and manage this catastrophic condition. METHODS: In this study, 33 consecutive patients with IVROBA diagnosed by computed tomography (CT) were treated. Basic and therapeutic parameters were evaluated as independent predictive factors of a poor prognosis by using univariate analysis. The factors were statistically analyzed based on the interval between initial symptoms and IVROBA. RESULTS: Patients with a good outcome were younger (<21 yr old) (P < 0.003) and had fewer complications after IVROBA (P < 0.03). For the most part, these patients had undergone aspiration for brain abscess with ventricular drainage combined with the immediate administration of appropriate intravenous and intrathecal antibiotics (P < 0.02). In just a short time, abscesses located in the parieto-occipital region ruptured into the ventricle (P < 0.004), and those with nonsterile cultures (P < 0.01) developed into IVROBA. Just before IVROBA, patients had severe headaches, signs of meningeal irritation, and a rapidly deteriorating clinical condition within 10 days after the signs of meningeal irritation developed. A CT scan obtained before IVROBA ascertained localized enhancement of the ventricular wall adjacent to the abscess. CONCLUSION: Our findings suggest that signs of meningeal irritation and localized enhancement of the ventricular wall adjacent to the abscess, as observed on CT scans, preceded IVROBA. To decrease the mortality rate associated with purulent brain abscesses, signs forewarning of IVROBA should be recognized, and aggressive management of IVROBA should be initiated. Aggressive CT-guided aspiration of deep-seated abscesses, particularly in the parieto-occipital region, at the time forewarning signs of IVROBA are observed lead to the prevention of IVROBA and an improvement in outcome.
机译：目的：阐明脑脓肿脑室内破裂（IVROBA）患者的前驱体征和影响预后的临床因素，以预防和管理这种灾难性疾病。方法：本研究对33例经计算机断层扫描（CT）诊断为IVROBA的连续患者进行了治疗。通过单因素分析将基本和治疗参数作为不良预后的独立预测因素进行评估。根据初始症状和IVROBA之间的间隔对因素进行统计学分析。结果：预后良好的患者较年轻（<21岁）（P <0.003），IVROBA术后并发症较少（P <0.03）。在大多数情况下，这些患者因脑脓肿而接受脑室引流术，并立即给予适当的静脉内和鞘内抗生素治疗（P <0.02）。在短时间内，位于顶枕区域的脓肿破裂进入脑室（P <0.004），而具有非无菌培养物的脓肿（P <0.01）发展为IVROBA。在IVROBA即将发生之前，患者出现严重的头痛，脑膜刺激征和在出现脑膜刺激征后的10天内迅速恶化的临床状况。在IVROBA之前获得的CT扫描可确定邻近脓肿的心室壁的局部增强。结论：我们的发现表明，在CT扫描中观察到，在IVROBA之前出现了脑膜刺激征和邻近脓肿的心室壁局部增强的迹象。为了降低与脓性脑脓肿相关的死亡率，应认识到IVROBA的预警迹象，并应积极进行IVROBA处理。强烈的CT引导下深部脓肿的抽吸，尤其是在顶枕区域，在观察到IVROBA的预警迹象时，可预防IVROBA并改善预后。

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