PDF(Pubmed)
Abstract：
Arcanobacterium haemolyticum, found as normal flora in healthy individuals, is an unusual culprit for pharyngitis and sinusitis in young adults, rarely leading to severe infections. Here, we present a singular case involving a 19-year-old immunocompetent male who experienced complications arising from A haemolyticum sinusitis, leading to orbital and intracranial sinogenic complications. The patient developed severe cerebral vasospasm with delayed cerebral ischemia, necessitating aggressive management encompassing daily catheter-directed intra-arterial infusions, surgical source control, and maximal medical therapy. This case explores the challenging diagnostic and management aspects associated with cerebral artery vasospasm secondary to bacterial meningoencephalitis. The abrupt neurological decline in such patients presents a dilemma in recognizing the occurrence of cerebral vasospasm versus the progression of meningoencephalitis. By utilizing computed tomography brain perfusion scans, we were able to identify delayed cerebral ischemia due to cerebral vasospasm, acknowledging that this modality was not used to identify classical territorial stroke infarcts. This decision was made based on the understanding of the potential for bacterial-induced cerebral vasospasm to involve both hemispheres.
摘要：
溶血性弧菌，作为健康个体的正常菌群，是年轻人咽炎和鼻窦炎的不寻常罪魁祸首，很少导致严重感染。这里,我们提出了一个单例病例，涉及一名19岁的免疫功能正常的男性，他经历了由溶血性鼻窦炎引起的并发症。导致眼眶和颅内窦源性并发症。患者出现严重脑血管痉挛伴迟发性脑缺血,需要积极的管理，包括每日导管导向的动脉内输注，手术源控制，和最大的药物治疗。此案例探讨了与细菌性脑膜脑炎继发的脑动脉血管痉挛相关的具有挑战性的诊断和管理方面。这些患者的神经系统突然下降在识别脑血管痉挛的发生与脑膜脑炎的进展方面存在困境。通过利用计算机断层扫描脑灌注扫描，我们能够发现脑血管痉挛引起的迟发性脑缺血,承认这种模式没有用于识别经典的领土中风梗塞。做出此决定是基于对细菌引起的脑血管痉挛累及两个半球的可能性的理解。
