化脓性脑膜炎的多学科综合诊治-魏俊吉.pptVIP

Diagnosis – First Impression Imp：Intracranial infection Purulent meningitis Enterococcus casseliflavus infection Communicating Hydrocephalus Encephalopyosis (infratentorial subdural) Chronic suppurative otitis media (Rt.ear) Multi-Consultation Reports 1. Purulent meningitis is evidenced with relevant examinations, sensitive antibiotic should be considered 2.The ventricular system was enlarged, along with ↑ ICP. Lumbar Puncture (LP) was contraindicated. External ventricular drainage (EVD) is indicated for ↑ ICP. Operation day Patient performed Right Side EVD immediately after admission ，ICP 300mmH2O，CSF Transparency: opaque. Patient was then transferred to ICU after the operation. Amoxicillin and clavulanate potassium was administered； Valproate acid sodium was administered for epilepsy； Mannitol for ICP ↓ ； Post-Op day 1 The Patient regained consciousness in day 1. GCS:E4V5M6. Able to respond questions in detail, able to follow basic commands。 CSF：1049*10^6/L，1045*10^6/L，Polynucleate 77%；Biochem：GLu 4.0mmol/L（BG 9.7mmol/L），CL118mmol/L，Pro 1.05g/L。 Cranial CT: EVD tube is well positioned，Ventricular system has shrinked significantly。 Following days Fever has decreased，neurological PE has improved significantly EVD tube was unobstructed，the fluid was lightly yellow and cloudy。 The patient’s condition was stable，and was later transferred to Infection Department。 Infection Department Anti-Infection and prophylactic Epilepsy Cranial CT : encephaledema，EVD tube was well positioned; Cranial MRI Contrast Tentorial enhancement, right subtentorial reflected two circular enhanced lesions, with possibility of abscess remnant. Encephaledema, cochlea surrounding showed structural disorder Post-Op day 7 CSF: WBC count 26*10^6/L，polynucleate 8；Biochem：GLu 4.2mmol/L，CL 115mmol/L，Pro 0.99g/L。 Multi CSF Germiculture (-) 。 1210MR C+ --I month in PUMCH 2013-12-23 Cranial CT s