RESUMEN
Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature.
Asunto(s)
Colesteatoma del Oído Medio/complicaciones , Empiema Subdural/etiología , Infecciones por Escherichia coli/etiología , Mastoiditis/complicaciones , Adulto , Antibacterianos/uso terapéutico , Colesteatoma del Oído Medio/diagnóstico , Colesteatoma del Oído Medio/terapia , Descompresión Quirúrgica , Drenaje , Empiema Subdural/diagnóstico , Empiema Subdural/terapia , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Mastoiditis/diagnóstico , Mastoiditis/terapia , Grupo de Atención al PacienteRESUMEN
Chronic rhinosinusitis is currently diagnosed on history-taking with nasendoscopic confirmation. Sinus x-rays are insensitive and non-specific but are still requested, particularly by primary care physicians. The rate of sinus x-rays can be reduced by informing GPs of current best practice guidelines.
Asunto(s)
Radiografía/estadística & datos numéricos , Rinitis/diagnóstico por imagen , Sinusitis/diagnóstico por imagen , Enfermedad Crónica , Adhesión a Directriz , Humanos , Auditoría Médica , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Servicio de Radiología en Hospital , Sensibilidad y EspecificidadRESUMEN
Iatrogenic injury to the spinal accessory nerve following surgical procdures in the neck is well recognized in causing significant morbidity to patients, with shoulder pain and loss of function being particularly problematic. We have used a Magstim Neurosign 100 peripheral nerve monitor, that is most often used in our practice to monitor the facial nerve during middle ear and parotid surgery, to monitor the accessory nerve during neck surgery. Ten patients undergoing accessory nerve-sparing neck dissection, or excision biopsy of neck mass had their accessory nerve monitored during the procedure. No patient suffered injury of the nerve. In several cases the nerve closely adhered to the tissue being resected, and in two cases, the nerve bifurcated or gave off branches. We found that the monitor aided identification and preservation of the nerve.