Epidural abscess in children
Introduction
Introduction to pediatric epidural abscess Due to various reasons, epidural septic inflammation, abscess formation, meningeal irritation and various damage, called epidural abscess. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: sepsis herpes zoster epilepsy
Cause
Causes of pediatric epidural abscess
(1) Causes of the disease
The routes of infection are:
1. Direct spread of adjacent infections: such as skull osteomyelitis destroys the inner plate of the skull. Frontal sinusitis destroys the posterior wall of the frontal sinus Otitis media or mastoiditis destroys the tympanic cap of the rock bone or the anterior wall of the sigmoid sinus can cause epidural empyema in the corresponding site.
2. Blood infection: scalp edema or facial infection can spread through the vein of the skull to the epidural space to form an abscess, and purulent embolism phlebitis is also more common.
3. Foreign body retention after open craniocerebral injury is also the most common source of infection. The most common pathogen of epidural abscess secondary to sinusitis is streptococcus. Staphylococcus aureus or Staphylococcus epidermidis is a common pathogen of epidural abscess caused by post-traumatic infection and skull osteomyelitis; Gram-positive bacilli infection is also seen.
(two) pathogenesis
The pathological changes of the epidural abscess depend on the virulence of the pathogen, the body's resistance and the length of the infection. The early response to the infection is the congestion and exudation of the outer layer of the dura mater, followed by tissue necrosis and a large number of inflammatory white blood cells. Infiltration, followed by abscess formation or fibrin deposition, if the bacteria virulence is small, the body is strong, local granulation tissue can be formed, and finally transformed into fibrous tissue scars.
Prevention
Prevention of epidural abscess in children
Prevention and treatment of various infectious diseases Active treatment of various infectious diseases, prevention of otitis media, frontal sinusitis, facial infections, etc. caused by spread or blood line spread to the disease.
Complication
Pediatric epidural abscess complications Complications sepsis herpes zoster epilepsy
Formation of symptoms of infection or sepsis, combined with subdural empyema, formation of abscess sinus, secondary to herniated sinusitis, herpes zoster, secondary to mastoiditis and otitis media may appear trigeminal nerve Other sequelae such as epilepsy can occur in the damage of the nerves.
Symptom
Pediatric epidural abscess symptoms Common symptoms Increased intracranial pressure, high fever, chills, cold, nausea, herpes, body discomfort, dull pain, allergies
In the acute phase, there are systemic reactions caused by infection, such as general discomfort, chills, high fever, and increased blood levels. Localized headache is also a common symptom. Most headaches are persistent dull pain. The position is consistent with the location of the epidural abscess. For the local dura mater is affected by inflammatory stimuli, children with severe infection may have high fever, chills, convulsions, convulsions and meningeal irritation. In patients with subdural empyema, brain tissue edema and increased intracranial pressure may occur. Symptoms, headache, nausea and vomiting and local nervous system localization, but because of the dense dural tissue, simple epidural abscess is often more limited, the symptoms of increased intracranial pressure and cerebrospinal fluid inflammatory cells are often not obvious, abscess enters After the chronic phase, the clinical symptoms are alleviated, and the epidural abscess caused by various causes has different characteristic manifestations. For example, children with secondary foreign body retention after cranial osteomyelitis or trauma often have local swelling, forming abscess sinus, when abscess Clinical symptoms can be significantly alleviated after extensive exclusion; children with secondary sinusitis often have frontal and periorbital skin swelling and along the supraorbital nerve Distribution of herpes zoster and sensory allergy zone, and sputum pain; secondary to mastoiditis and otitis media in children with swelling and tenderness of the mastoid root, if the abscess develops invading the tip of the rock, Symptoms of ipsilateral trigeminal and augmentation nerves (rock tip syndrome) appear.
Examine
Examination of pediatric epidural abscess
1. Peripheral blood: white blood cell count and neutrophil increase, nuclear left shift and toxic particles can occur.
2. Lumbar puncture: combined with subdural empyema can increase cerebrospinal fluid pressure and white blood cell count, but the simple localized epidural abscess is not obvious.
3. Skull X-ray film: visible bone abscessation and absorption of bone and the formation of dead bones, also helpful for the discovery of infection sources, such as frontal sinusitis, thickening of frontal sinus mucosa, effusion; mastoiditis The hardening of the mastoid air chamber, bone destruction or the formation of epidermoid tumors can be seen.
4. CT examination: visible fusiform low-density lesions under the inner plate of the skull, the scope is limited, the brain tissue is under pressure, and the enhanced banding of the inner edge of the inflammatory reaction is a characteristic image of the disease. Performance, the accumulation of gas in the abscess can appear "gas-liquid plane", in addition to CT can also find the primary lesions such as skull osteomyelitis.
5. MRI: It is characterized by a clear fusiform signal zone under the boundary of the inner plate of the skull. The T1 image shows a slightly longer T1 signal between the brain tissue and the cerebrospinal fluid. The T2 image is higher than the brain tissue signal. If the protein content of the abscess When high, the signal intensity is enhanced, and the inner edge of the abscess is a hard film that is under pressure and can be curved and strengthened.
Diagnosis
Diagnosis and diagnosis of pediatric epidural abscess
For children with skull osteomyelitis, frontal sinusitis, otitis media, mastoiditis and adjacent scalp spasm, if there is generalized infection symptoms, localized headache and skin swelling and tenderness, or meningeal irritation, the disease should be considered. may.
Need to pay attention to the identification of epidural hematoma: epidural hematoma often has a history of trauma, acute hematoma on CT is high density, the density value is higher than abscess; subacute hematoma can be high, low and mixed density, but The enhanced scan showed no arc-shaped enhancement of the inner edge of the capsule. The MRI scan of the subacute hematoma showed high signal on both T1 and T2 images, while the abscess showed a low or equal cortical signal on the T1 image and a slightly higher signal on the T2 image.
