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頁籤選單縮合
題名 | Osteomyelitis of Skull Base: A Case Report and Review of the Literature=顱底骨髓炎一病例報告 |
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作者 | 楊容欣; 胡蓮欣; 張承培; 朱任公; 王世楨; 劉仁賢; | 書刊名 | 核子醫學暨分子影像雜誌 |
卷期 | 25:2 2012.06[民101.06] |
頁次 | 頁100-103+a13 |
分類號 | 416.26 |
關鍵詞 | 頭痛; 顱底骨髓炎; 單光子電腦斷層攝影; 骨骼掃描; Headache; Skull base osteomyelitis; SPECT; Tc-99m MDP bone scan; |
語文 | 英文(English) |
中文摘要 | 惡性外耳炎意指嚴重的外耳道感染並擴及外耳道的骨組織,其中最常見的影響與老年糖尿病患者的嚴重感染。在一些患者中,病程可能會進展為顱底骨髓炎。早期診斷和積極治療,以減少病情惡化的風險是重要的。在此我們提出一個病例報告,這個顱底骨髓炎的患者一開始以頭痛表現。這個案例之所以特別,是因為在她的外耳道最初沒有明顯的感染跡象,電腦斷層和MRI也沒有明確的發現。病人的骨掃描顯像顯示在顱底有一個活性(active)骨病變。因此她被診斷為顱底骨髓炎並用抗生素,之後頭痛改善了。有趣的是之後的MRI影像證實病人有顱底骨隋炎。由此病例,作者認為在老人或免疫功能低下的病人,嚴重的、不明原因的頭痛,或伴有顱神經病變的情況下,非典型顱底骨髓炎應列入鑑別診斷。當然,這類的病人仍應該排除潛在的惡性疾病的可能。 |
英文摘要 | Background: Malignant external otitis is a severe infection of the external auditory canal and most often affects elderly patients with diabetes mellitus. In some patients, it may progress to skull base osteomyelitis. Early diagnosis and aggressive treatment are crucial to reduce risks of dissemination. Case Report: We report a case of a 91-year-old patient with skull base osteomyelitis presenting with severe headache. There was no obvious initial sign of infection at the patient's external ear canal. Combined osteomyelitis bone scan (Tc-99m methylenediphosphonic acid bone scan and gallium scan) and magnetic resonance imaging revealed an active bone lesion in the skull base. The patient was treated with antibiotics for skull base osteomyelitis and the headache improved. Conclusions: The authors concluded that, in the elderly or immunocompromised patient, headache with active bone lesion on imaging should raise the possibility of skull based osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause. |
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