Empiemas subdllrales intracraneales
A. Isla, F. Alvarez, V. Pepín, M. García-Blázquez
Hospital «La Paz». Servicio de Neurocirugía. Madrid
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García-Blázquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Isla" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Alvarez" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Pepín" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "García-Blázquez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Hospital «La Paz». Servicio de Neurocirugía. Madrid" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec162265" "palabras" => array:3 [ 0 => "Empiema subdural" 1 => "Sinusitis" 2 => "Otitis" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec162266" "palabras" => array:3 [ 0 => "Subdural empyema" 1 => "Sinusitis" 2 => "Otitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Se presentan 16 casos de empiema intracraneal extraídos de una serie de 90 abscesos intracraneales tratados en nuestro hospital desde 1978 a 1990, lo que representa una frecuencia del 17,7%. Las edades de los pacientes variaron entre 8 meses y 44 años siendo la media de 25 años. Clínicamente predominaron los síntomas de hipertensión intracraneal seguidos de fiebre y disminución del sensorio. La localización de los empiemas fue frontal en 8 casos, parietal en 2, temporal en 2 y en fosa posterior en el ángulo pontocerebeloso en 4 casos. Las causas etiológicas más frecuentes fueron sinusitis en 7 casos, y otitis en 6. Once de los doce pacientes con empiemas supratentoriales fueron tratados con cirugía la cual consistió en craneotomía en 8 casos y trépanos evacuadores en 3. Los 4 pacientes con empiemas localizados en la fosa posterior fueron tratados con craniectomía. En un caso se utilizó tratamiento médico con antibióticos y control con TAC. En 10 de los 16 casos el examen bacteriológico fue positivo, siendo los gérmenes predominantes el estreptococo y estafilococo. Todos los pacientes una vez diagnosticados recibieron una combinación de dos o más antibióticos variándose el tipo del mismo según la especificidad del cultivo del líquido obtenido. De los 16 casos 12 siguieron una buena evolución y 4 fallecieron tras empeoramiento neurológico. La craniectomía parece el tipo de tratamiento más efectivo empleándose el tratamiento médico exclusivo en los casos muy localizados y sin focalidad clínica. El tratamiento del foco originario es preceptivo.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sixteen cases of subdural empyema extracted from a series of 90 intracranial abscesses seen in our service between 1978 and 1990 are presented. Thus, empyemas represent 17,7% of the total. The age of the patients ranged from 8 months to 44 years, the average being 25 years. Headache, vomiting fever and confusion were the predominant symptoms. Empyemas 10cated at frontal level in eight cases, at parietal level in two, at temporal level in two, and in the posterior fossa at level of the cerebello-pontine angle in four cases. The most frequent etiological causes were sinusitis in seven cases and otitis in six.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eleven supratentorial empyemas were treated surgicaIly; eight patients with evacuation through a craniotomy and three by means of burrholes. All patients with infratentorial empyema were treated by craniectomy. Bacteriological examination was positive in ten of the 16 cases, and multiple microorganisms were found in five cases, streptococcus and staphylococcus being the predominant germs. All patients were treated with antibiotics according to the bacteriological study. Craniotomy seems to be the most effective surgical treatment. Only one patient was treated exclusively with antibiotics.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The outcome was good in twelve cases and four patients died. A medical or surgical treatment of the original focus is mandatory.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Isla, A.; Alvarez, F.; Pepín, V.; García-Blázquez, M.:Empiernas subdurales intracraneales. Neurocirugía 1992; 3: 212–216.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of subdural empyema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Bannister" 1 => "B. Willians" 2 => "S. 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