複雜深頸感染致脊椎長節硬腦膜外膿瘍併休克之案例討論及文獻探討

Pan-spinal Epidural Abscess Caused by Complicated Deep Neck Infection with Shock: Case Report and Literature Review

脊椎長節硬腦膜外膿瘍為罕見的嚴重感染病症，常為其他部位嚴重感染導致之複雜感染。其臨床表現通常會導致誤導性體徵和症狀。感染病變本身會擴大以壓迫脊髓，導致嚴重症狀、永久性並發症，甚至死亡。本個案報告研究並分析一名 69 歲男子因突然四肢癱瘓、肩下麻木、血流動力學狀態不穩定和呼吸衰竭被送入急診室。影像學檢查顯示頸部深部感染、右側胸膜外膿胸和頸-胸-腰椎硬膜外膿腫。病人接受先於急診接受插管、膿胸手術清創和抗生素治療，待生命徵象穩定後接受頸椎第1-3節椎板切除術及膿腫清創術。經過6週的抗生素治療和復健治療，病人手腳無力的症狀得到很大改善。

 

Spinal epidural abscess is an uncommon but critical central nervous infection. It can be life threatening and result in severe morbidity. We presented with a case of pan-spinal epidural abscess with relation to deep neck infection, empyema and shock. He had sudden quadriplegia with numbness below shoulder, unstable hemodynamic status and respiratory failure. Emergency intubation, surgical debridement of the em-pyema and prescription of antibiotics were the initial treatments. His vital signs grad-ually stabilized and then he received surgical decompression of C1-3 laminectomy and debridement of the spinal abscess. After the antibiotic treatment and rehabilitation for 6 weeks his hands and legs weakness got much improving and can have oral intake by himself. Pan-spinal epidural abscess usually involves many other medical problems, therefore resulting poor physical condition and poor prognosis. With interdisciplinary teamwork and critical care medicine there is more and more evidence supporting that surgical intervention with antibiotic treatment and rehabilitation is recommended for the patient with pan-spinal epidural abscess