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題名 | Infective Endocarditis Complicated with Thalamic Infarction and Mycotic Aneurysm Rupture: A Case Report=感染性心內膜炎併發視丘梗塞與細菌性動脈瘤破裂:一病例報告 |
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作者 | 洪思群; 戴慶泰; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:1 1998.01[民87.01] |
頁次 | 頁53-58 |
分類號 | 415.3164 |
關鍵詞 | 感染性心內膜炎; 細菌性動脈瘤; 視丘梗塞; Infective endocarditis; Mycotic aneurysm; Thalamic infarction; |
語文 | 英文(English) |
中文摘要 | 一39歲女性患有二尖瓣脫垂之病人,於胃癌手術後四個月,忽然感覺左側顏面及肢體麻木。心臟超音波顯示有二尖瓣贅生物,血液並培養出腸球菌。病人在感染性心內膜炎合併視丘梗塞的診斷下,住院接受進一步治療。在適當的抗生素投與四週之後,病人突然發生意識模糊的現象,影像學檢查顯示為細菌性動脈瘤破裂合併顱內出血。經緊急開顱手術取出血塊後,病人復原情況良好。但六週之後,不幸發生再出血,病人於深昏迷五天後不治死亡。 二尖瓣脫垂的病人相當普遍。當伴隨收縮期雜音,或有瓣膜增厚或冗長時,罹患感染性心內膜炎的危險便明顯提高。應於侵入性治療前後,依據美國心臟協會建議,接受預防性抗生素。 感染性心內膜炎及其併發症的表現,可能如本病例一般瑣細。臨床醫師應有高度警覺才不致延誤診斷與治療之時機。有鑑於細菌性動脈瘤破裂導致顱內出血的高死亡率,我們建議當病人表現出局部神經缺陷或有警示性頭痛時,應做腦血管攝影檢查,以及早發現並切除病灶。 |
英文摘要 | A 39-year-old female with mitral valve prolapse experienced left side hemisensory disturbance four months after gastric surgery. Echocardiogram disclosed vegetation on the mitral valve and blood cultures showed growth of enterococcus. With a diagnosis of thalamic infarction complicating infective endocarditis, she was hospitalized for further treatment. After four weeks of antibiotic therapy, she developed sudden headache and obtundation. Imaging studies revealed intracerebral hemorrhage (ICH), resulting from mycotic aneurysm rupture. She survived and recovered after emergency craniotomy and evacuation of the hematoma. However, the ICH recurred six weekslater and the patient died after five days in a deep coma. Patients with mitral valve prolapse are common. Those who have systolic murmur or valvular thickening and redundancy are at particular risk of infective endocarditis and should receive antibiotic prophylaxis perioperatively as recommended by the American Heart Association. Clinical manifestations of infective endocarditis and its complications, as in our patient, are often trivial. Prompt diagnosis and intervention are crucial. In view of the poor prognosis associated with ICH due to mycotic aneurysm rupture, we suggest cerebral angiography be performed in patients presenting with focal neurologic deficits or with warning headache for early detection of accessible lesions for excision. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。