ICM:双侧基底节对称性脑脓肿

2018-06-03 杨中华 脑血管病及重症文献导读

29岁,男性。既往发现二叶主动脉瓣3级。发热,偏瘫4天,GCS评分14分。

29岁,男性。

既往发现二叶主动脉瓣3级。

发热,偏瘫4天,GCS评分14分。

经胸和经食道超声心动图显示主动脉瓣穿孔(perforation),可见较大赘生物(30 mm)突入左室,以及一个较小的二尖瓣赘生物(4 mm)。左室射血分数为60%。

平扫CT显示基底节低密度病变。入院第4天时MRI flair显示双侧基底节坏死性病变。DWI、ADC和T1增强皆符合脑脓肿的诊断

下图,入院第4天MRI DWI显示双侧基底节近对称高信号(a),ADC呈现明显低信号(b)。增强T1显示脑脓肿中心坏死核心,周围可见完整光滑的强化(c)。抗生素治疗2个月后随访MRI T1强化显示脓肿变小,壁强化增厚:





立即给予抗生素治疗。血培养为乳酸乳球菌乳脂亚种(Lactococcus lactis cremoris)。因为脓肿的部位,未采取神经外科活检或引流。随后患者进行了双瓣膜置换术。

2个月随访发现脓肿明显变小(上图d)。

原始出处:
Monique Boukobza, et al. Bilateral basal ganglia abscesses in infectious endocarditis: an uncommon complication.  Intensive Care Med. April, 2018.

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    2018-06-06 cxg966504

    好东西.感谢分享

    0

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    2018-06-05 张新亮1853311252142e2fm

    好文献学习了

    0

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    2018-06-04 qjddjq
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    2018-06-04 hunizi009
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  7. [GetPortalCommentsPageByObjectIdResponse(id=321791, encodeId=c04e321e91ed, content=好东西.感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/05/28/7730a2ceddef8c4a7b8f726be3f9e566.jpg, createdBy=ec271557270, createdName=cxg966504, createdTime=Wed Jun 06 02:57:31 CST 2018, time=2018-06-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321564, encodeId=c528321564ee, content=好文献学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b5a62240667, createdName=张新亮1853311252142e2fm, createdTime=Tue Jun 05 07:00:39 CST 2018, time=2018-06-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1488474, encodeId=024214884e491, content=<a href='/topic/show?id=2e14850433b' target=_blank style='color:#2F92EE;'>#脑脓肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85043, encryptionId=2e14850433b, topicName=脑脓肿)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=35d88422796, createdName=qjddjq, createdTime=Mon Jun 04 23:59:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1522406, encodeId=9b31152240623, content=<a href='/topic/show?id=46223e39897' target=_blank style='color:#2F92EE;'>#双侧#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37398, encryptionId=46223e39897, topicName=双侧)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=741b11453403, createdName=wangbingxhy, createdTime=Mon Jun 04 23:59:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1537264, encodeId=8db4153e264cc, content=<a href='/topic/show?id=8a988520e74' target=_blank style='color:#2F92EE;'>#脓肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85207, encryptionId=8a988520e74, topicName=脓肿)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d01712842068, createdName=hunizi009, createdTime=Mon Jun 04 23:59:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1582369, encodeId=d50b15823693c, content=<a href='/topic/show?id=1f634206545' target=_blank style='color:#2F92EE;'>#基底节#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42065, encryptionId=1f634206545, topicName=基底节)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=823916911991, createdName=41514492@qq.com, createdTime=Mon Jun 04 23:59:00 CST 2018, time=2018-06-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321110, encodeId=5e353211101f, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun Jun 03 09:59:24 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321100, encodeId=d6a43211003f, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sun Jun 03 09:45:11 CST 2018, time=2018-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=321088, encodeId=790d32108871, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6Nx0VGA4QMDzOP8oAgnV4h51EjSfehJ9QxyiaSmw8PB56BhY8KXFSxHCibXrzcy4abrzSibXQPxJ9kzrLcJyhhB8a/0, createdBy=1d3b1672603, createdName=明月清辉, createdTime=Sun Jun 03 09:11:56 CST 2018, time=2018-06-03, status=1, ipAttribution=)]
    2018-06-03 龙胆草

    学习谢谢分享

    0

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    2018-06-03 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

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    2018-06-03 明月清辉

    谢谢分享.学习了

    0

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