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[A case of subdural empyema with transient cerebral white matter lesions]
Abstract:
We reported a fourteen years old male with subdural empyema followed by consecutive magnetic resonance imaging (MRI) examination. He was admitted to our hospital, complaining incomplete paresis of the left upper extremities, headache and high fever. The first MRI T2-weighted image at admission revealed an abnormal high intensity in the right frontal subdural space, indicating an abscess. Antibiotics therapy and a burr hole operation were effective and he made a remarkable recovery. One month later, the third MRI T2-weighted image showed an abnormal high intensity in the deep white matter of the right frontal lobe, which had not been detected in the subsequent MRI after the operation. On the other hand, the meningeal enhancement on the second Gd-DTPA enhanced MRI was more thickened than the previous meningeal enhancement. This abnormal high intensity on MRI had disappeared two month later, when the meningeal enhancement had grown thin. These data suggested the meningeal enhancement was relative to the transient high intensity which was considered to represent brain edema. We concluded that careful observation and serial MRI examination might be necessary in patient with subdural empyema even after disappearance of all symptoms.
Insights
Subdural empyema in a teen resolved with treatment, but follow-up MRI revealed transient brain edema. Serial magnetic resonance imaging (MRI) is crucial for monitoring patients even after symptom resolution.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Subdural empyema is a serious intracranial infection requiring prompt diagnosis and management.
- Magnetic resonance imaging (MRI) is essential for visualizing the extent of infection and complications.
Observation:
- A 14-year-old male presented with symptoms of subdural empyema, including weakness, headache, and fever.
- Initial MRI confirmed a right frontal subdural abscess, successfully treated with antibiotics and surgery.
- Follow-up MRI revealed transient high signal intensity in the deep white matter, suggestive of brain edema, correlating with meningeal enhancement.
Findings:
- The subdural empyema resolved, but a delayed finding of white matter edema was observed.
- Meningeal enhancement on contrast-enhanced MRI correlated with the transient brain edema.
- Both the white matter edema and meningeal enhancement resolved over time.
Implications:
- Serial MRI monitoring is vital in subdural empyema cases, even after apparent clinical recovery.
- Understanding transient white matter changes and their relationship with meningeal enhancement is important for accurate interpretation.
- This case highlights the potential for subtle, delayed radiological findings post-infection that may warrant continued observation.