脊髓硬膜外脓肿

最后审阅: 2 十一月 2022
最后更新: 17 五月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 发热
  • 脊椎疼痛或压痛
  • 四肢无力
  • 麻痹
  • 感觉障碍
  • 反射异常
更多 关键诊断因素

其他诊断因素

  • 单独括约肌功能障碍
其他诊断因素

危险因素

  • 静脉毒品使用
  • 近期脊柱手术或创伤
  • 留置脊髓导管
  • 邻近部位的局部感染
  • 免疫抑制
  • 糖尿病
  • 慢性肾病
  • 伴发菌血症或心内膜炎
  • 酒精滥用
  • 男性
  • 肥胖
  • 非邻近部位的合并感染(不包括细菌感染)
  • 慢性肝病
更多 危险因素

诊断性检查

首要检查

  • 全血细胞计数(FBC)
  • C 反应蛋白 (CRP)
  • 红细胞沉降率
  • 含和不含静脉注射造影剂的脊柱 MRI
  • 血液培养
更多 首要检查

需考虑的检查

  • 直接脓肿抽吸进行培养
  • 抽吸物的聚合酶链反应(PCR)
更多 需考虑的检查

治疗流程

初步治疗

疑似硬膜外脓肿

急症处理

甲氧西林敏感金黄色葡萄球菌(MSSA) 感染

MRSA 感染

革兰氏阴性菌感染

合并结核杆菌感染

撰稿人

作者

Kenneth F. Casey, MD
Kenneth F. Casey

Associate Adjunct Professor

Clinical Associate Professor of Physical Medicine and Rehabilitation

Wayne State University School of Medicine

Clinical Associate Professor Surgery (Neurosurgery)

Michigan State University

Detroit

MI

利益声明

KFC is a member of the Medical Advisory Board Facial Pain Association, an editor of the Medicine online journal, and a reviewer for World Neurosurgery (all unpaid), and teaches at Michigan State and Wayne State Volunteer faculty.

Farrin A. Manian, MD, MPH, FACP, FIDSA, FSHE

Chair

Department of Medicine

Mercy Hospital-St. Louis

St. Louis

MO

利益声明

FAM is an author of references cited in this topic.

同行评议者

John M. Embil, MD, FRCPC

Consultant

Infectious Diseases

Associate Professor

Section of Infectious Diseases

Department of Medicine

University of Manitoba

Director

Infection Prevention and Control Unit Health Sciences Centre

Winnipeg

Manitoba

Canada

利益声明

JME declares that he has no competing interests.

Iain Christie, MB BhB, FRCA

Consultant Anaesthetist

Derriford Hospital

Plymouth

UK

利益声明

IC declares that he has no competing interests.

Wendy Ziai, MD, MPH

Assistant Professor

Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine

The Johns Hopkins University

Baltimore

MD

利益声明

WZ declares that she has no competing interests.

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