title: [A case of infected subdural hematoma accompanied by cerebral infarction].
abstract: Infected subdural hematoma(ISH)is a rare disease caused by hematogenous infection of a preexisting subdural hematoma. We report a rare case of ISH accompanied by cerebral infarction. A 76-year-old man who had suffered a closed head injury 3 months before presented fever, headache and left hemiparesis during the medical treatment of acute cholangitis and obstructive jaundice with pancreatic cancer at the department of surgical gastroenterology. At the consultation, computed tomography(CT)scan indicated right chronic subdural hematoma. We performed a burr hole opening surgery on the same day. Abscess and hematoma was aspirated from the subdural space, and methicillin-resistantStaphylococcus aureus(MRSA)was detected in this specimen. Thus the diagnosis of the infected subdural hematoma was confirmed. However, despite the antibiotics therapy, follow-up CT showed a low-density area close to the residual abscess, which suggested cerebral infarction. Cerebral angiography showed a vasospasm at the cortical segment of the right middle cerebral artery near the residual abscess. Eventually we carried out a small craniotomy to evacuate the abscess. Our case showed that prompt surgical treatment is required in case of ISH and the whole hematoma and abscess should be removed as soon as possible with an image diagnosis and an additional surgical operation.
authors: Department of Neurosurgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
authors: Norio
authors: N
authors: Fujii
authors: Yuichiro
authors: Y
authors: Naito
authors: Shigehiko
authors: S
authors: Takanashi
authors: Toshiaki
authors: T
authors: Ueno
authors: Tadayoshi
authors: T
authors: Nakagomi
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D006408:Hematoma, Subdural / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013355:Subdural Space / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome