145.3 🩺 內科專科考前版

145.3.0.1 1️⃣ 22E 更新

• MR spectroscopy + DWI essential for differentiating from tumor
• 16S rRNA PCR on abscess aspirate when culture-negative
• Endovascular interventional drainage at major centers
• Neuroinfectious diseases multidisciplinary team approach
• HIV with intracerebral mass + CD4 < 100: empirical anti-toxoplasma 2-3 wks → if no response → biopsy (lymphoma vs other)

145.3.0.2 2️⃣ Spinal Epidural Abscess Surgical Window

• 24-48 hr from neuro deficit onset is critical
• Beyond this → permanent deficit risk ↑↑
• Modern series: 80% good recovery if drained < 24 hr; only 30% if > 72 hr

145.3.0.3 3️⃣ 台灣 context

• DM foot → bacteremia → spinal epidural abscess 經典 in 台灣
• IVDU → spinal epidural / brain abscess + IE
• Klebsiella pneumoniae brain abscess (hvKp) — same hypervirulent strain causing liver abscess; 多 DM 病人
• TB tuberculoma + meningitis 需考慮 endemic context

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