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asbryobvrz · Wysłany: Sob 8:00, 05 Mar 2011

Misdiagnosis of pyogenic osteomyelitis of the spine of two cases

1.2 The clinical manifestations of 13 patients with typical symptoms and signs of SAH, expressed as intracranial hypertension symptoms, including 3 cases of coma, 5 patients with paroxysmal convulsions,[link widoczny dla zalogowanych], and 1 side of the restricted movement of limbs, brain examination were not See exception. All CT scan of brain, 8 patients showed signs of SAH imaging,[link widoczny dla zalogowanych], but no intracranial mass lesions and brain parenchymal hemorrhage; more than 7 cases were normal. Line incidence of lumbar puncture and examination 3 days in 13 cases, 12 cases of bloody cerebrospinal fluid, 8 cases of cerebrospinal fluid pressure> 200mmH2O. 15 patients underwent cerebral angiography (DSA) inspection, 2 cases of 2 contrast, were not found exception. 1.3 Treatment and prognosis based on clinical manifestations, imaging and DSA, except for hemorrhagic stroke of other diseases, diagnosis of primary SAH, and click here to give appropriate treatment. 15 cases herein are quiet and bed rest, and to reduce intracranial pressure, bleeding, nutrition drug treatment of brain cells, of which 1 patient died 2nd SAH; more than 14 patients hospitalized 7-2O days, returned to normal discharge, follow-up six months no longer the disease, and 1O case has fully returned to normal. 2 Classification and discussion 2.1SAH pathogenesis of a variety of causes of SAH are caused by a class of hemorrhagic stroke, divided into two categories of primary and secondary. The bottom of primary SAH congenital cerebral aneurysm,[link widoczny dla zalogowanych], brain surface area of the malformation, atherosclerotic aneurysm】 J, malformation or aneurysm rupture due. Cause of SAH of unclear clinical 9% to 20%. 3j, this group accounts for the same period 15 patients (78 cases) SAH 442 * to go in the sudden appearance of the right lower limb weakness, several hours after the development of complete paralysis, paraplegia was acute compression process. The incidence of patients with a paraspinal purulent infection from the lungs of a vertebral body of a purulent infection of spinal paraplegia of a subacute onset of a process. 2.2 ① on the history of diagnosis and treatment should be carefully collected and carefully,[link widoczny dla zalogowanych], and from a number of surface phenomena for the nature of disease; ② medical technology do not meet the general inspection, to the neglect of serious physical examination, thus missing some valuable signs; ③ to develop good clinical thinking habits,[link widoczny dla zalogowanych], improve logical analysis capabilities, reduce misdiagnosis. (Received Time :2005-01-21) 19.2%, consistent with those reported. 2.2.1 cause 2.2SAH small aneurysm: aneurysm rupture due to disappear after a small, so the line does not develop imaging may be small aneurysm in the artery bifurcation, caused by cerebral angiography is not easy identify and missed. Small vascular malformation 2.2.2: a small vascular malformation rupture into the subarachnoid space, it is bloody cerebrospinal fluid, and cerebral angiography and negative, it is often misdiagnosed based disease. However, most of the formation of small vascular malformation rupture of parenchymal hematoma, hematoma by CT scan is found, we suggest that small vascular malformations exist, however, occurred in the spinal cord vascular malformations, such as no obvious clinical signs, once the bleeding, diagnosis will be very difficult. Reported 1 case of SAH, cerebral angiography negative, 1 year recurrence of SAH, by the beginning of the brachial artery angiography clearly as a spinal cord vascular malformations. 2.2.3 Other causes: cerebral thrombosis or cerebral embolism can cause yellow staining of cerebrospinal fluid, and small arteries near the spinal cord membrane rupture, the diagnosis more difficult, because the inner diameter 300 ~ 500m below the vascular disease, angiography beyond There are documented in the literature diagnostic boundaries confirmed by autopsy pial small artery wall necrosis caused by SAH reported l.