Rapidly developing subdural empyema in an adult with sinusitis: A neurosurgical threat alert (original) (raw)
Related papers
Subdural empyema secondary to sinus infection in children
Child's Nervous System, 2009
Objective To evaluate the impact, on morbidity and mortality, of aggressive surgical management of subdural empyema of sinus origin in children. Method The authors conducted a retrospective review of 20 children admitted between 2000-2007 to Alder Hay Children Hospital and The Walton centre for Neurology and Neurosurgery for subdural empyema secondary to sinus infection. Clinical presentation, duration of symptoms, radiological investigations, surgical treatment and post-operative outcome were evaluated. Results Outcome was favourable in 19 cases. In four cases, there were re-accumulation requiring surgical evacuation, four patients experienced post-operative seizures but were seizure-free at follow-up. There was only one mortality in the series. Conclusion Subdural empyema secondary to sinus infection, although uncommon, it could be associated with a relative high morbidity and mortality rate. Early aggressive surgical and medical management with drainage of intracranial or sinus collections and antibiotics therapy lead to a low mortality or morbidity rate and good clinical outcome.
case repOrt Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness
2012
While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures, confusion, and focal arm weakness after a bout of sinusitis. [West J Emerg Med. 2012;13(6):509-511]
Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness
Western Journal of Emergency Medicine, 2012
While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures, confusion, and focal arm weakness after a bout of sinusitis. [
Complicated Subdural Empyema in an Adolescent
Archives of Clinical Neuropsychology, 2012
Little is known regarding typical neuropsychological outcomes of intracranial empyema, a rare complication of sinusitis marked by accumulation of purulent material adjacent to the brain. A 15-year-old, right-handed male presented with a 3-day history of congestion, lethargy, fever, headache, dizziness, unequal pupil dilation, and right-sided facial droop. Computed tomography revealed right-sided subdural empyema causing subfalcine, central, foraminal uncal, and tonsillar herniation. Postoperative inpatient neuropsychological consultation was requested 17 days postsurgery due to language deficits. Through comparison of neuropsychological and radiological findings, this case of subdural empyema demonstrates the anatomical and functional impact of mass effect on the brainstem and the vasculature of the contralateral hemisphere. Deficits were observed in expressive language, processing speed, and fine motor functioning, all of which lingered 6 months postacute. This case study reviews the pathophysiology of subdural empyema and illustrates its potential neuropsychological impact to inform clinicians encountering this rare condition.
International Surgery Journal, 2017
Subdural empyema is a rare complication that causes high morbidity and mortality following sinusitis. Cranial complications should be considered in patients who develop neurological symptoms. These patients need surgery that should be performed by neurological and ear-nose-throat surgeons working together. A 14-year-old girl developed aphasia and hemiparesis from retrograde thrombophlebitis following sinusitis and we planned a two-stage surgery for the patient. In the first step, we drained the empyema by a craniotomy and functional endoscopic sinus surgery. In the second step, we drained a mature abscess. The purpose of this paper is to review the surgical and clinical management of intracranial complications from sinonasal infections.
Infratentorial Subdural Empyema Associated with Long Standing Occipital Dermal Sinus: Case Report
Infratentorial subdural empyema is a rare form of life threatening intracranial infection, requiring immediate neurosurgical intervention. We present this 4-years-old girl with posterior fossa subdural empyema which is associated with congenital occipital dermal sinus. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that raised suspicion of a subdural empyema with supratentorial mild ventricular dilatation which was confirmed by MRI with contrast. The patient was operated through sub-occipital decompression and drainage of the collection and the samples was sent for culture and sensitivity. Dermal sinus can be a cause for intracranial infection and should be investigated to rule out intradural connection. Infratentorial subdural empyema should be managed urgently by neurosurgical intervention to prevent further life threatening complications.
Child's Nervous System
Background Subdural empyema denotes the collection of purulent material in the subdural spaceand is commonly seen in infants and older children. In infants, the most common cause is bacterialmeningitis. In older children, sinusitis and otitis media are usually the source for subdural empyema. Theclinical symptomatology is varied and has a wide range including prolonged or recurrent fever, seizures,meningeal irritation, and raised intracranial pressure. It can mimic as well as complicate meningitis and aheightened clinical awareness is therefore paramount. Aims and Objectives The clinical profile, etiopathogenesis, imaging features and management of subdural empyema in children is discussed and the relevant literature is reviewed. Conclusion Subdural empyema is a neurosurgical emergency and rapid recognition and treatment canavoid life-threatening complications. In most cases, surgical decompression through burr hole or craniotomyis warranted. Near complete evacuation of the purulent material and appropriate long-term intravenous antibiotics are necessary for a gratifying outcome.
Multidisciplinary management and outcome in subdural empyema--a case report
Chirurgia (Bucharest, Romania : 1990)
Cranial subdural empyema (SDE), a localized septic intracranial collection, occurs mostly as a complication of sinusitis, otitis or mastoiditis. Although relatively rare, SDE requires an increased attention for early recognition, cerebral imagery being mandatory in any suspected case. Any delay in treatment can lead to coma with a fatal outcome. The authors report the case of a young boy, who developed a severe, important cerebral edema, thin subdural collection with minimal displacement of the median line. Repeated cerebral MRI showed an enlarged subdural collection with higher median line shift and imposed rapid surgical intervention. The collection proved to be empyema. Other findings on MRI are pansinusitis, mild mastoiditis and transverse sinus thromboflebitis. The recovery was accompanied by the need for long course of antibiotherapy, secondary epilepsy treatment and kinetotherapy for hemiparesis. The patient also developed intracerebral cysts expanding the brain through the p...
Surgical Treatment Outcome of Subdural Empyema: A Clinical Study
Pediatric Neurosurgery, 2006
A retrospective study of 28 patients identified with subdural empyema (SE) at the Department of Neurosurgery between the years 1995 and 2005 was carried out. SE occurred in all patients following bacterial meningitis. The six most frequently encountered clinical features included: (1) fever in 22 (79%) patients; (2) disturbed consciousness in 16 (57%) patients; (3) papilledema in 11 (39%) patients; (4) hemiparesis in 4 (14%) patients; (5) meningismus or meningeal signs in 4 (14%) patients, and (6) seizures in 3 (11%) patients. In the majority of cases, the most frequent causative pathogen of SE was Staphylococcus aureus. Surgery was performed on all patients, which included craniotomy in a group of 20 patients and burr hole drainage in a group of 8 patients. In conclusion, we believe that infants and young children should be carefully monitored following meningitis, in case of SE development, and that surgical intervention in patients presenting with meningitis may facilitate the de...