Osteomyelitis of the skull
Introduction
Introduction to skull osteomyelitis Skull osteomyelitis is often caused by craniocerebral trauma, resulting in bacterial infection of the skull, causing inflammation, resulting in a series of clinical symptoms of the disease, the scope of infection can be limited to a skull, can also exceed the multiple invasion of the suture skull. basic knowledge The proportion of illness: 0.001% - 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: headache, thrombosis, abscess, epilepsy, brain edema
Cause
Causes of skull osteomyelitis
The skull is contaminated (30%):
The causes of skull osteomyelitis include: the skull is directly contaminated during the open injury process, and the debridement after injury is not timely enough or not appropriate in the treatment; the scalp injury combined with the wound infection spreads to the skull through the guiding blood vessel, or the scalp defect makes the skull Long-term exposure to necrosis and infection; open skull fracture involving the paranasal sinus, middle ear cavity and mastoid.
Scalp edema (30%):
Acute osteomyelitis in the calvarial area often manifests as scalp edema, pain, local tenderness, and when the infection spreads to the subperiosteum of the skull, a Potts puffy tumor may appear, and chronic skull osteomyelitis often appears to be long-lasting. Unhealed sinus, repeated ulceration, sometimes can discharge the dead bone fragments, long-term chronic skull osteomyelitis, bone sclerosis and hyperplasia around the destruction area, so X-ray film can Diagnosis, the scope of skull osteomyelitis can be limited to a skull, can also exceed the bone suture invading multiple skulls, sometimes due to retrograde thrombophlebitis, the infection spread from the subperiosteal or epidural to the skull, forming a hard Extraperitoneal empyema, subdural empyema and/or brain abscess.
Brain abscess (15%):
Brain abscess refers to the formation of purulent encephalitis, chronic granuloma and brain abscess caused by purulent bacterial infection, and a small part can also be caused by fungal and protozoal invasion into brain tissue. Brain abscess can occur at any age and is most common in young adults.
Prevention
Skull osteomyelitis prevention
After the traumatic brain injury, the wound should be treated in time, thoroughly debrided, and no foreign matter is left, which can prevent the disease from happening.
Complication
Skull osteomyelitis complications Complications headache thrombosis abscess epilepsy brain edema
1. Epidural empyema:
Skull osteomyelitis is more likely to be associated with epidural empyema, and occasionally due to incomplete debridement of open skull fractures. The scalp wounds often heal. These patients have headaches, fever, and lethargy in the early stage. After the formation of abscess, there are often symptoms of increased intracranial pressure and local brain tissue compression, such as hemiplegia, aphasia or signs of nerve ablation. CT scans show a fusiform image resembling an epidural hematoma, which is low in density at an early stage and gradually changes to one week later. Equal density or high density shadow, due to inflammatory granulation hyperplasia in the dura mater of the lesion area, can make the dura of the convex bulge significantly enhanced, showing a dense curved band. If it is a gas-producing bacteria infection, the liquid level may appear. And the gas.
2. Subdural empyema:
Can occur after the skull osteomyelitis, but also due to the early treatment of penetrating head injury caused by infection, usually in secondary to severe nasal sinusitis, early patients often have headaches, fever and neck stiffness, etc. Later, gradually increased intracranial pressure such as headache, sorrow, vision loss and lethargy, but often lack of localization signs, more easily missed diagnosis, sometimes due to subdural empyema caused by cerebral hemisphere compression or cortical surface vein Thrombosis, neurological dysfunction, such as hemiplegia, aphasia or hemianopia, in addition, there are more opportunities for local epilepsy, up to 30%, the exact diagnosis depends on cerebral angiography, CT and MRI imaging Cerebral angiography can not only see the cortical blood vessels away from the inner plate of the skull, but also the capillary growth of the granulation tissue surrounding the abscess. The CT scan is mostly the crescent-shaped low density immediately below the inner plate of the skull. District, often accompanied by large cerebral edema, encephalitis, white matter infarction and the midline structure of the obvious shift, enhanced CT can appear clear boundaries, uniform thickness of the thin band, accompanied by skin Venous thrombosis and encephalitis, often appear cerebriform local enhancement film, MRI performance signal is below T1-weighted image in the brain parenchyma, the cerebrospinal fluid higher than, the image signal is higher than T2-weighted brain parenchyma, the cerebrospinal fluid slightly lower.
Symptom
Skull bone marrow inflammation symptoms common symptoms fatigue skull hyperplasia lymphadenopathy cold war meningitis brain abscess fever
In the acute phase, the local scalp is red, swollen and tender, and other inflammatory reactions. The scalp may have edema in the distance, adjacent lymph nodes may be enlarged, and may be accompanied by systemic symptoms such as fever, burnout, chills, etc. The peripheral blood may be increased from cells, such as treatment is not timely or Inflammation is not controlled, infection can be extended to the brain or extracranial, forming a subperiosteal abscess, an epidural abscess can be formed into the skull, meningitis or brain abscess, infectious venous sinus embolism.
Skull infection prolonged can be converted into chronic osteomyelitis, local manifestations may have scalp under the scalp or rupture into a sinus, the sinus sometimes closed, sometimes ruptured pus, pus can be mixed with necrotic small bones, when When the drainage is not smooth, local and systemic symptoms increase.
Examine
Examination of skull osteomyelitis
Laboratory inspection
Blood routine may have increased white blood cells in the peripheral blood.
Film degree exam
1. Skull X-ray film
Generally, changes can be made on the X-ray 2 to 3 weeks after the infection of the skull. 90% of the lesions are map-like bone destruction, the boundary is fuzzy, or the worm-like bone density is reduced. The chronic one can have bone around the bone destruction area. The hardening zone has a clearer boundary, and half of them have free dead bones. The dead bones are irregular in shape and vary in size. The lesions can be single or multiple or more diffuse.
2. Brain CT scan
Contribute to the diagnosis of intracranial abscess, combined with epidural or subdural abscess, the presence of a diamond-shaped low-density area outside the skull inside the skull, and a uniform band-like enhancement at the inner edge of the enhanced examination, accompanied by adjacent brain tissue Edema.
Diagnosis
Diagnosis and differentiation of skull osteomyelitis
According to the local manifestations of the head and the X-ray film of the skull, it is generally not difficult to make a diagnosis. Because of scalp infection, skull osteomyelitis and intracranial abscess are often closely related. CT scan should be performed for suspected intracranial abscess.
The disease through the medical history and typical symptoms, it is not difficult to differentiate the diagnosis.
