未矫正的法洛四联症并发脑脓肿及术后颅内出血：一例病例报告

文献信息

中文摘要

背景： 脑脓肿是发绀型先天性心脏病的一种罕见但可能致命的并发症，其中慢性缺氧、红细胞增多症和右向左分流使菌血症绕过肺滤过。方法：一名20多岁的女性，患有未矫正的法洛四联症，表现为严重头痛、右侧无力和癫痫发作。检查显示偏瘫、感觉减退和反射亢进；血液检查显示继发性红细胞增多症和白细胞增多。未发现牙科、鼻窦、耳科或呼吸道来源。结果：未增强计算机断层扫描显示左侧顶叶占位性病变伴中线移位，超声心动图证实法洛四联症伴肺动脉闭锁。她接受了头孢曲松、甲硝唑和地塞米松治疗，随后进行了钻孔引流。恢复过程因硬膜外出血需要紧急开颅手术以及后来的硬膜下血肿伴局灶性癫痫发作而复杂化，两者均成功处理。结论：本病例表明，未矫正的紫绀型心脏病中出现新的局灶性神经体征需要紧急影像学检查以排除脑脓肿，并且红细胞增多症会增加围手术期出血风险。

英文摘要

Cerebral abscess is a rare but potentially fatal complication of cyanotic congenital heart disease, in which chronic hypoxia, polycythaemia and right-to-left shunting allow bacteraemia to bypass pulmonary filtration. A woman in her 20s with uncorrected tetralogy of Fallot presented with severe headache, right-sided weakness and seizures. Examination showed hemiparesis, hypoaesthesia and hyperreflexia; blood tests revealed secondary polycythaemia and leucocytosis. No dental, sinus, otological or respiratory source was identified. Unenhanced computed tomography demonstrated a left parietal space-occupying lesion with midline shift, and echocardiography confirmed tetralogy of Fallot with pulmonary atresia. She received ceftriaxone, metronidazole and dexamethasone, followed by burr-hole drainage. Recovery was complicated by epidural haemorrhage requiring emergency craniotomy and a later subdural haematoma with focal seizures, both managed successfully. This case illustrates that new focal neurological signs in uncorrected cyanotic heart disease warrant urgent imaging for brain abscess, and that polycythaemia compounds perioperative haemorrhagic risk.