한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제19권6호
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  • Pages.275-279
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  • 2018
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
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만성부비동염을 가진 환자에서 재발된 뇌농양 : 증례보고

Recurrent Brain Abscess In Chronic Sinusitis : A Case Report

  • 이상학 (원광대학교의과대학 신경과학교실) ;
  • 황용 (원광대학교의과대학 응급의학교실) ;
  • 이학승 (원광대학교의과대학 신경과학교실)
  • Yi, SangHak (Department of Neurology, Wonkwang University, School of Medicine) ;
  • Hwang, Yong (Department of Emergency Medicine, Wonkwang University, School of Medicine) ;
  • Lee, Hak Seung (Department of Neurology, Wonkwang University, School of Medicine)
  • 투고 : 2018.03.12
  • 심사 : 2018.06.01
  • 발행 : 2018.06.30
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초록

뇌농양은 심각한 신경학적 후유증을 일으킬 수 있는 중추신경계 감염이다. 신경집중치료 발달에도 불구하고, 여전히 뇌농양은 특정 위험 환자에게 높은 사망률을 보이고 있다. 특히 세균성 뇌농양은 즉각 진단 및 적절한 항생제 치료가 필요한 응급 상황이다. 또한 드물게 뇌농양이 재발되는 경우도 있다. 본 연구에서는 두통으로 내원한 59세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료분석을 하였다. 59세 남자가 두통을 주소로 내원하였고, 연속적으로 시행한 뇌자기공명영상과 뇌척수액 검사에서 우측 전두엽에 뇌농양을 확인하였고, 항생제 치료 및 수술적 치료 후 완치하였다. 퇴원 후 5개월 뒤 두통 및 경기 증상 있어 다시 촬영한 뇌자기공명영상에서 뇌농양의 재발이 확인되었다. 뇌농양 재발은 특정 조건, 즉, 농양 부위에 이물질이 남아 있거나 만성 부비동염, 동정맥루, 좌우션트 등이 있을 때 생길 수 있다.

A brain abscess is caused by an infection in the central nervous system and leads to significant neurological sequelae. Despite advances in neurocritical care, high morbidity and mortality rates are still associated with brain abscess, especially in certain high-risk patients. Thus, a brain abscess is a medical emergency requiring prompt diagnosis and treatment with antibacterial therapy. However, the recurrence of brain abscess is rare. A 59-year-old man presented at our neurology clinic with a headache and was found to have chronic otitis media. Serial brain magnetic resonance imaging (MRI) scans of the patient demonstrated a brain abscess in the right frontal lobe. Following stereotactic aspiration of the brain abscess and proper antimicrobial treatment, the patient recovered completely. Five months after discharge, the patient revisited our clinic with a headache and seizure symptoms, and recurrence of the brain abscess was confirmed by brain MRI. Recurrent brain abscess has been documented in patients with predisposing conditions such as retained foreign bodies, chronic sinusitis, arteriovenous fistula, and right-to-left shunt.

키워드

참고문헌

  1. Beller AJ, Sahar A, Praiss I, "Brain abscess. Review of 89 cases over a period of 30 year," J Neurol Neurosurg Psychiatry, vol. 36, pp. 757-768, 1973. DOI: https://doi.org/10.1136/jnnp.36.5.757
  2. Carpenter J, Stapleton S, Holliman R, "Retrospective analysis of 49 cases of brain abscess and review of the literature," Eur J Clin Microbiol Infect Dis, vol. 26, pp. 1-11, 2007. DOI: https://doi.org/10.1007/s10096-006-0236-6
  3. Park SH, Lee SW, Kang DH, Hwang JH, "Sung JK, Hwang SK : The role of f-fluorodeoxyglucose positron emission tomography in the treatment of brain abscess," J Korean Neurosurg Soc, vol. 49, pp. 278-283, 2011. DOI: https://doi.org/10.3340/jkns.2011.49.5.278
  4. Rosenblum ML, Hoff JT, Norman D, "Weinstein PR, Pitts L : Decreased mortality from brain abscesses since advent of computerized tomography," J Neurosurg, vol. 49, pp. 658-668, 1978. DOI: https://doi.org/10.3171/jns.1978.49.5.0658
  5. Yang SY, "Brain abscess : a review of 400 cases," J Neurosurg, vol. 55, pp. 794-799, 1981. DOI: https://doi.org/10.3171/jns.1981.55.5.0794
  6. Yang SY, Zhao CS, "Review of 140 Patients with Brain Abscess," Surg Neurol, vol. 39, pp. 290-296, 1993. DOI: https://doi.org/10.1016/0090-3019(93)90008-O
  7. Adams RD, Victor M, "Nonviral infections of the nervous system, In: Adams RD, Victor M, eds. Principles of neurology," New York, McGraw-Hill Inc pp. 629-630, 1993.
  8. Mathisen GE, Johnson JP, " Brain abscess," Clin Infect Dis, vol. 25, pp. 763-779, 1997. DOI: https://doi.org/10.1086/515541
  9. LaBarbera M, Berkowitz MJ, Shah A, Slater J, "Percutaneous PFO closure for the prevention of recurrent brain abscess," Catheter Cardiovasc Interv, vol. 68, pp. 957-960, 2006. DOI: https://doi.org/10.1002/ccd.20869
  10. Kikuchi K, Kowada M, Shioya H, Shioya T, "Recurrent brain abscess associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease)--case report," Neurol Med Chir (Tokyo) Vol. 32, pp. 891-895, 1992. https://doi.org/10.2176/nmc.32.891
  11. Kikuchi K, Kowada M, Shioya H, Shioya T, "Recurrent brain abscess associated with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease)--case report," Neurol Med Chir (Tokyo), vol. 32, pp. 891-895, 1992. DOI: https://doi.org/10.2176/nmc.32.891
  12. Vandertop WP, de Vries WB, van Swieten J, Ramos LM, "Recurrent brain abscess due to an unexpected foreign body," Surg Neurol, vol. 37, pp. 39-41, 1992. DOI: https://doi.org/10.1016/0090-3019(92)90063-S
  13. Caroli M, Arienta C, Rampini PM, Balbi S, "Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung," Neurochirurgia (Stuttg), vol. 35, pp. 167-170, 1992. DOI: https://doi.org/10.1055/s-2008-1052272
  14. Quagliarello V, Scheld WM, "Bacterial meningitis : Pathogenesis, pathophysiology, and progress," NEJM, vol. 327, pp. 864-872, 1992. DOI: https://doi.org/10.1056/NEJM199209173271208
  15. Park TH, Kim MK, " Bacterial Menigitis and Brain Abscess," J Neurocrit Care Suppl. 1, pp S63-S68, 2008.
  16. Fulgham JR, Wijdicks EF, Wright AJ, "Cure of a solitary brainstem abscess with antibiotic therapy: case report," Neurology, vol. 46, pp. 1451-1454, 1996. DOI: https://doi.org/10.1212/WNL.46.5.1451
  17. Carpenter JL, "Brain stem abscesses: cure with medical therapy, case report, and review," Clin Infect Dis, vol. 18, pp. 219-226, 1994. DOI: https://doi.org/10.1093/clinids/18.2.219
  18. Yousaf I, McInstry CS, Choudhari RA, "Recurrent intracranial abscess after a long latency," Br J Neurosurg, vol. 18, pp. 396-397, 2004. DOI: https://doi.org/10.1080/02688690400005271
  19. Ciurea AV, Stoica F, Vasilescu G, Nuteanu L, "Neurosurgical management of brain abscesses in children," Childs Nerv Syst, vol. 15, pp. 309-317, 1999. DOI: https://doi.org/10.1007/s003810050400
  20. Patel K, Clifford DB, "Bacterial brain abscess," Neurohospitalist, vol. 4, pp. 196-204, 2014. DOI: https://doi.org/10.1177/1941874414540684
  21. Cavusoglu H, Kaya RA, Turkmenoglu ON, Colak I, Aydin Y, "Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period," Neurosurg Focus, vol. 24, E9, 2008.
  22. Gadgil N, Patel AJ, Gopinath SP, "Open craniotomy for brain abscess: a forgotten experience," Surg Neurol Int, vol. 4, pp. 34, 2013. DOI: https://doi.org/10.4103/2152-7806.109522
  23. Park JH, Yoo DS, Kim DS, Huh PW, Cho KS, Kang JK, "Continuos irrigation of brain abscess using a double lumen catheter," J Korean Neurosurg Soc, vol. 29, pp. 1328-1322, 2000.
  24. Sharma R, Mohandas K, Cooke RP, "Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside," Infection, vol. 37, pp. 39-43, 2009. DOI: https://doi.org/10.1007/s15010-008-7359-x
  25. Ko SJ, Park KJ, Park DH, Kang SH, Park JY, Chung YG, "Risk factors associated with poor outcomes in patients with brain abscesses," J Korean Neurosurg Soc, vol. 56, pp. 34-41, 2014. DOI: https://doi.org/10.3340/jkns.2014.56.1.34