Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
Intracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2artment with a 4-week history 0Í right-sided earache associated with a foul smelling purulent discharge. He had suffered from intermittent ear discharge since childhood, but he had been well for the previous year. The current episode had been treated with a 1-week course of antibiotics by the genera Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2l practitioner without any effect. The patient then developed general malaise, positional headaches, and was now describing intermittent horizontal veEbook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
rtigo, the sensation of movement as if the environment were spinning. There were no meningitis symptoms. He had no headache, neck stiffness, or photopIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2he right external auditory meatus was completely occluded by pus and the pinna was pushed anteriorly.The patient was admitted under the ear. nose, and throat surgeons who requested routine laboratory investigations and a microbiology swab that was sent for microscopy. culture, and sensitivity. A CT Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2scan was performed and the CT images are shown in Figure 11.1.A diagnosis of mastoiditis was made and the patient was placed on the emergencytheatre lEbook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
ist for an exploratory mastoidectomy. How-even the next day the patient was noted to have developed a mild right-sided hemiparesis and was referred toIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2riventricular hydrocephalus and displacement of the IVth ventricle.It was felt these images were consistent with cerebritis and a Tl, T2 and T2 FLAIR MR scan was requested (Figure 11.3). Additionally, a T1 scan with contrast (Figure 11.4). diffusion-weighted imaging (Figure 11.5) and magnetic resona Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2nce venography (MRV) was performed (Figure 11.6).© Expert commentThe classic clinical triad of headache, high temperature, and focal neurological defiEbook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
cit occurs in <50% of cases When no obvious source of infection B identified an extensive septic •work up IS mandatory.0 Expert commentThe role of steIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2ause of morbidity and modality in patients with brain abscess. When the patient is on a targeted antibiotic treatment, administration of dexamethasone, in the presence of oedema on imaging, is often an essential pan of the patient's management. Long-term use should be discouragedRapidly deterioratin Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2g patients referred from district general hospitals requiring urgent treatment can have, prior to transfer, administration of bread spectrum antibiotiEbook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
csand dexamethasone after Obtaining blood cultures.104Challenging concepts in neurosurgeryFigure 11.1 CT scan with bone windows demonstrates a nght-siIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2stoid process is well aerated and normal in appearance (white line arrows).The imaging studies demonstrated cerebellar and right mastoid abscesses in keeping with an otogenic origin. The MRV showed patent sinuses and large veins, with no signs of lateral sinus thrombosis (Figure 11.6). Cultures obta Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2ined from the ear canal swab grew Group A beta haemolytic streptococci and Pseudomonas and the patient was started on intravenous ceftriaxone. 2g bd,Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
and clindamycin. 600mg qds.Case 11 Intracranial abscess■ xs-Jhypodensay (white block arrows).o Learning point Stages of brain abscess formation StagesIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2n abscessStageDayMicroscopic featuresMRIT1MRIT1 + contrastEady cerebriti$0-3Acute inflammatory reaction with polymorphonuclear leukocytes. Fibroblasts appear and angiogenesis begins.Pooily-defined hypo/ Patchyenhancement isointense les»onLate45025Necrosis. MacrophageHypointense centreIntense irregul Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2ar nmcerebntiSrecruitment. Neovascularization and associated vasogenic oedema. Fibroblastic collagen deposition.and iso/hyperintense rimenhancementEarEbook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2
ly45212Progressive central necrosisCentre becomesWell-defined, thin-walledcapsuleand collagen deposition m capsule. Peripheral gliosismore hy pen ntenIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depa Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2ple layers of colleger! capsule form surrounded by increasing numbers of reactive asvocytes.cavity may collapsepossible cavity collapse. Capsule IS thicker on cortical Side and thinner on ventride Side.Swnandouras 6 The Nevrosu^wns Handle*. 2011 Oxford University Press.106Challenging concepts in neu Ebook Oxford challenging concepts in neurosurgery - Cases with expert commentary (1/E): Part 2rosurgeryIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depaIntracranial abscessCiaran Scott HillCD Expert commentary George SamandourasCase historyA 20-year-old right-handed man presented to the Emergency depaGọi ngay
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