ガス産生菌による脳膿瘍と硬膜下膿瘍の同時合併例—手術時期についての考察

A Case of Gas-producing Brain Abscess with Subdural Empyema:Timing of the operation for brain abscess

I．はじめに

　ガス産生菌による脳膿瘍は極めて稀であり^{2,3,9-11,13,16）}，しかも非ガス産生菌による脳膿瘍に比して急速に増大し，予後も不良である^4,9,11）．

　今回われわれは，神経脱落症状を残すことなく完治させることができたガス産生菌による脳膿瘍と硬膜下膿瘍との同時発生例を経験したので，文献的考察を行うと共に脳膿瘍の手術時期についても検討したので報告する．

A case of gas-producing brain abscess with subdural abscess was reported.

An 18-year-old boy was admitted with a five-day his-tory of vomiting and high grade pyrexia. Plain skull roentgenograms demonstrated left frontal multiple gas bubbles. CT scan and MRI showed that both brain and subdural abscesses contained gas in the left frontal area. Antibiotics and glyceol were intravenously admi-nistrated. In serial CT scans, subdural abscess was not recognized, while brain abscess was enhanced in a ring.Seven days after admission, milky white pus with a fec-al odor was aspirated using CT guided stereotactic apparatus, and the catheter was left in the abscess cav-ity. Culture of the pus grew peptostreptococcus. On the 22nd hospital day, repeated aspiration and drainage were performed for the residual brain abscess. The patient gradually improved after the aspiration with continuous administration of antibiotics, and he was discharged on the 59th hospital day with no neuro-logical deficits.

Based on our experience and a review of the litera-ture, the treatment of choice is aspiration in the late cerebritis stage of brain abscess.