脑脓肿一--台湾_洪桢邦.pptVIP

下载本文档

6
0
约1.19万字
约 43页
2017-05-22 发布于江西
举报
版权申诉

脑脓肿一--台湾_洪桢邦.ppt

1、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。。
2、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
3、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
4、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
5、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
6、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
7、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

脑脓肿一--台湾_洪桢邦

presented by Ri 洪楨邦 Introduction A focal collection of pus surrounded by a well-vascularized capsule (encephalitis: inflammation of brain) The brain is remarkably resistant to bacterial and fungal infection∵ - abundant blood supply - blood-brain barrier (simple bacteremia is very rare) Brain abscess -Pathophysiology 1 Direct spread from adjacent infection (20~60 % , via valveless emissary veins to cavernous sinus) 2 Hematogenous spread 3 Penetrating brain injury 4 Neurosurgery-related 5 Cryptic (20%~30%) Direct spread Hematogenous spread … Most commonly in MCA territory Chronic pulmonary infection: lung abscess, empyema or bronchiectasis Skin infection Pelvic infection Intraabdominal infection Endoscopic sclerosis of esophageal varices Bacterial IE Cyanotic congenital heart disease (children) Furen Xiao, Ming-Yuan Tseng, Lee-Jene Teng, Ham-Min Tseng, Jui-chang Tsai,Brain abscess: clinical experience and analysis of prognostic factorSurgical neurology 63(2005):442~450 Collect data from 1986~2002 178 pt(130 males and 48 females) Age: 2 months to 84 years 60 % aged 20~60 y/o, 9%10 y/o Clinical Manifestation Clinical Triad of brain abscess only in 13% Headache(70~95%): dull aching, generalized, with N/V; severe and refractory to NSAID; but not as abrupt as SAH or acute meningitis Fever(60%): not reliable indicator Focal neurological deficit(45%): hemiparesis, aphasia, visual disturbance Seizure on admission (16%) Neck stiffness(15%); Papilledema(23~50%) Clinical Manifestation Nonspecific, dx is made at a mean of 11 days (1~60 d) after the onset of symptoms GCS on admission: wide range: GCS 15(65%), 14(6%), 9~13(17%), 5~8(11%) PE: Cranial vault infection dental abscess, otitis media, or sinusitis CN III, VI deficit ? IICP Sudden worsening of pre-existing headache: abscess rupture into ventricle Brain abscess -Laboratory Little value in the diagnosis Mild leukocytosis 20,000 per mm3 B/C only positive in 15 % Lumb