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[Clinical thinking and decision making in practice. A student with sudden headache]
R Saxena1, W P Vandertop, G L Küppers
1Afd. Neurologie, Academisch Ziekenhuis Rotterdam-Dijkzigt. saxena@neur.azr.nl
Nederlands Tijdschrift Voor Geneeskunde
|May 17, 2000
Summary
A severe headache can signal an intracranial infection. Prompt surgical drainage and antibiotics are crucial for treating epidural and subdural empyema, leading to complete recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intracranial infections can present with severe headache.
- Pus collections can form in epidural or subdural spaces.
- Differentiating between epidural and subdural empyema is critical due to prognosis.
Observation:
- An 18-year-old male presented with sudden severe headache, fever, nausea, and vomiting.
- Neurological decline manifested as left-sided hemiparesis.
- Brain imaging revealed pansinusitis with frontal epidural empyema, followed by a right-sided subdural empyema.
Findings:
- Surgical drainage of the frontal epidural empyema was performed.
- Deterioration led to surgical evacuation of the right-sided subdural empyema.
- Long-term high-dose intravenous antibiotic therapy resulted in complete recovery.
Implications:
- Sudden severe headaches warrant investigation for intracranial infections.
- Epidural empyema generally has a favorable prognosis with prompt treatment.
- Subdural empyema poses a higher risk of severe complications and requires urgent intervention.
- Multidisciplinary management involving antibiotics and surgical drainage is essential for favorable outcomes.