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首页> 外文期刊>Neurosurgery >Intracranial tuberculous subdural empyema: case report.
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Intracranial tuberculous subdural empyema: case report.

机译：颅内结核性硬膜下积液：病例报告。

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OBJECTIVE AND IMPORTANCE: Many types of neurotuberculosis have been described; the most common intracranial forms are tuberculous meningitis and tuberculomas. We report a unique and as yet unreported form of neurotuberculosis, which is an intracranial tuberculous subdural empyema. CLINICAL PRESENTATION: A 59-year-old man who had been previously treated for pulmonary tuberculosis (TB) presented at our institution with a long-standing history of headaches. General and neurological examinations revealed no abnormalities. Radiography of the chest confirmed fibrotic lung changes caused by healed pulmonary TB. A cranial computed tomographic scan revealed a hypodense extra-axial collection with mass effect as well as adjacent osteitis and scalp swelling. INTERVENTION: The patient underwent craniectomy of the osteitic bone and drainage of 50 ml of fluid pus located subdurally. Microscopic examination of the bone and pus revealed tuberculous granulation tissue with numerous acid-fast bacilli identified using Ziehl-Neelsen stain. Mycobacterium TB bacillus was cultured from the pus at 42 days. The patient required two further operative procedures as well as a protracted course of anti-TB therapy. CONCLUSION: The patient eventually achieved a good recovery. We recommend surgical drainage of tuberculous subdural empyema to relieve mass effect and to obtain microbiological confirmation. Furthermore, surgical treatment should be combined with an 18-month course of anti-TB chemotherapy, during which period patient compliance should be closely monitored.
机译：目的和重要性：已经描述了许多类型的神经结核;这些疾病的发生与发展有关。最常见的颅内形式是结核性脑膜炎和结核瘤。我们报告了一种独特的，尚未报道的神经结核形式，即颅内结核性硬膜下积脓。临床表现：一位曾经接受过肺结核治疗的59岁男子在我们机构出现了长期的头痛病史。常规和神经系统检查未发现异常。胸部X线检查证实，肺结核治愈后可引起肺纤维化。颅骨计算机断层扫描显示有质量效应的低密度轴外收集物，以及邻近的骨炎和头皮肿胀。干预：患者接受了颅骨骨的颅骨切除术并引流了位于硬膜下的50 ml脓液。骨骼和脓液的显微镜检查显示结核性肉芽组织具有大量使用Ziehl-Neelsen染色法鉴定的抗酸杆菌。第42天从脓液中培养出结核分枝杆菌。该患者需要进一步的两个手术程序以及延长的抗结核治疗疗程。结论：患者最终恢复良好。我们建议通过外科手术引流结核性硬脑膜下积液，以减轻肿块效应并获得微生物学证实。此外，手术治疗应与18个月的抗结核化学疗法相结合，在此期间应密切监测患者的依从性。

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