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[Interhemispheric subdural empyema in a patient with allergic rhinitis, pansinusitis and acute excerbation of frontal
1Department of Pediatrics, Oita Medical University.
Abstract:
We reported a 10-year-old boy with an interhemispheric subdural empyema caused by acute excerbation of frontal sinusitis. He has suffered from allergic rhinitis and pansinusitis for years. He had fever and a generalized tonic-conic seizure, followed by prolonged consciousness disturbance and right hemiparesis. CT and MRI were useful to diagnose an interhemispheric subdural empyema, which showed a characteristic double-layer fluid collection pattern. Prompt diagnosis and treatment with craniotomy resulted in recovery without any neurological sequelae. His basic disorders, allergic rhinitis and pansinusitis, were successfully treated with macrolides and antiallergic drugs: pranlukast hydrate and sodium cromoglicate, administered per os and by inhalation, respectively.
Insights
A pediatric case of interhemispheric subdural empyema, stemming from frontal sinusitis, highlights the importance of prompt diagnosis and surgical intervention for favorable outcomes in children.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Background:
- Interhemispheric subdural empyema is a rare but serious complication of sinusitis, particularly in pediatric patients.
- Allergic rhinitis and pansinusitis can predispose individuals to sinonasal infections and their intracranial complications.
Observation:
- A 10-year-old boy presented with fever, generalized tonic-clonic seizure, prolonged consciousness disturbance, and right hemiparesis.
- Imaging studies, including CT and MRI, revealed an interhemispheric subdural empyema with a distinctive double-layer fluid collection pattern.
Findings:
- Acute exacerbation of frontal sinusitis was identified as the cause of the interhemispheric subdural empyema.
- Prompt diagnosis and surgical management via craniotomy led to complete neurological recovery without sequelae.
- Concurrent treatment of underlying allergic rhinitis and pansinusitis with macrolides and antiallergic medications (pranlukast hydrate, sodium cromoglicate) was successful.
Implications:
- This case underscores the critical role of timely neurosurgical intervention in managing pediatric subdural empyemas.
- Effective management of chronic sinonasal conditions is essential for preventing severe intracranial infections in children.
- The characteristic imaging findings aid in the early and accurate diagnosis of interhemispheric subdural empyema.