PMC9719688_01
Brain CT after admission in patient with intracranial CRPK infection. (A) Before craniotomy on Apr 18. (B) After craniotomy on Apr 19. (C) After craniotomy on Apr 21, subdural effusion can be seen. (D) After craniotomy on Apr 24, a small amount of subdural effusion appeared. (E) After craniotomy on May 10, Subdural Effusion has developed significantly. (F) After cerebrospinal fluid leakage and intracranial infection on May 14, subcutaneous drainage tube was inserted, subdural Effusion decrease. (G) After cerebrospinal fluid leakage and intracranial infection on May 17, Subdural Effusion disappear. (H) enhanced CTbrain scanning showed no brain abscess on May 17. (I) After the treatment of anti-infective regimen on May 24. (J) After the treatment of anti-infective regimen on May 30, Ventricular Dilatation was observed.
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Physical examination on admission reported, coma, GCS score = E1V1M3 =5, muscle strength of the right limb level 0, with stabbing and flexion of the left limb, diagnosed with cerebral hemorrhage in the left basal ganglia region (Figure 1A); After admission, the left frontotemporal parietal craniotomy was performed for hematoma removal and decompression with bone flap removal. April 19 (Figure 1B) suggested that the hematoma in the left basal ganglia region had been cleared, the middle line was in the center, and the cistern was clearly displayed. After craniotomy on Apr 21, subdural effusion can be seen (Figure 1C). The head CT reexamination on April 24 (Figure 1D) indicated that residual hematoma and intraventricular hematoma in left basal ganglia region were basically absorbed, and effusion could be seen beside falx and subcutaneously. On May 10 (Figure 1E) showed that subcutaneous effusion significantly progressed. On May 11, due to the high tension of the flap, cerebrospinal fluid (CSF) leakage occurred in the wound, and the highest body temperature was 39.5 C. The head CT reexamination on May 14 (Figure 1F) showed a significant decrease in subcutaneous effusion. On May 17, the head CT reexamination (Figure 1G) indicated that the subcutaneous effusion of left frontotemporal parietal had disappeared, and CT enhancement (Figure 1H) showed no obvious enhancement. On May 24, the head CT (Figure 1I) showed no obvious hydrocephalus, subcutaneous effusion disappeared, the middle line was centered, and the cistern was clear. On May 30, slight hydrocephalus was observed (Figure 1J).
Location of subcutaneous drainage tube and method of compression in skull defect area. (A) Location of subcutaneous drainage tube. (B) A sport headband is used to pressurize the skull defect area.
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In order to solve the flap tension and continuous drainage, the decompression window flap was subcutaneous drainage (Figure 2A) and drainage tube was fixed (Figure 2B).
Changes in cerebrospinal fluid (CSF) in patient with intracranial A. baumannii infection before and after treatment. (A) CSF on May 19; (B) CSF on May 28.
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On May 19, the patient's body temperature continued to be above 39.5 C, and the CSF was cloudy (Figure 3A). On May 28, the patient's body temperature was normal, and the CSF white blood cells were 8x106/L, glucose was 2.41 mmol/L, protein was 1279.3mg/ L (Table 1), the CSF was clear (Figure 3B).