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Cranial epidural empyema with osteomyelitis caused by actinomyces, CT, and MRI appearance
J L Soto-Hernández1, V A Morales, J C Lara Giron
1Department of Infectious Diseases, Instituto Nacional de Neurología y Neurocirugía, Mexico, D.F., Mexico.
Abstract:
Actinomycosis is an uncommon cause of intracranial infection. Epidural empyema represents about 6% of CNS actinomycotic lesions. A case of an epidural empyema with parietal bone osteomyelitis caused by Actinomyces israelii is presented. Relevant neuroimaging features were bone erosions and a multiloculated collection with annular contrast enhancing on CT. Postoperative MRI revealed extensive involvement of the neighbor dura, falx, and subdural space. MRI was crucial to follow-up the response to antibiotic treatment.
Insights
Actinomycosis is a rare cause of brain infections. This case highlights Actinomyces israelii causing epidural empyema and parietal bone osteomyelitis, emphasizing neuroimaging
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Actinomycosis is an uncommon infectious disease, rarely affecting the central nervous system (CNS).
- Epidural empyema is a rare manifestation of CNS actinomycosis, accounting for approximately 6% of such lesions.
Observation:
- A case of intracranial infection involving epidural empyema and parietal bone osteomyelitis caused by Actinomyces israelii is detailed.
- Neuroimaging revealed characteristic features including bone erosions and a multiloculated collection with annular contrast enhancement on CT scans.
Findings:
- Postoperative Magnetic Resonance Imaging (MRI) demonstrated extensive involvement of adjacent dura mater, falx cerebri, and the subdural space.
- MRI proved essential for monitoring the patient's response to antibiotic therapy.
Implications:
- This case underscores the importance of considering actinomycosis in the differential diagnosis of intracranial infections, particularly with unusual imaging findings.
- Advanced neuroimaging techniques like MRI are critical for accurate diagnosis, surgical planning, and therapeutic monitoring in complex CNS actinomycotic infections.