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[Subdural empyema secondary to sinusitis: four pediatric cases]
J P Oliveira-Monteiro1, A L Duarte-Teles, M L Silva-Gonçalves
1Universidad de Neuropediatría y Desarrollo. Servicio de Pediatría. Hospital Garcia de Orta, Almada, Portugal. mocho66@hotmail.com
Revista De Neurologia
|September 18, 2002
Summary
Pediatric subdural empyema, a rare complication of sinusitis, requires high suspicion. Early diagnosis and prompt surgical intervention are crucial for favorable outcomes in children with neurological symptoms.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Perinasal sinus infections are common in children but intracranial extension, such as subdural empyema, is rare.
- Widespread antibiotic use has decreased the incidence, but delayed diagnosis can lead to significant morbidity and mortality.
Observation:
- A retrospective study identified four pediatric patients (ages 9-13) with subdural empyema secondary to sinusitis.
- Patients presented with sinusitis prodrome followed by fever, headache, vomiting, and neurological deficits, including altered consciousness and focal signs.
Findings:
- Medical management alone was insufficient; all patients required surgical intervention, with two needing repeat procedures.
- Cultures revealed Streptococcus milleri and anaerobic organisms.
- No mortality was observed, with a median follow-up of 32 months indicating a favorable prognosis with appropriate treatment.
Implications:
- Subdural empyema presentation can be nonspecific, necessitating a high index of suspicion in pediatric cases.
- Prompt neuroradiological investigation is vital for children with unexplained fever, neurological abnormalities, and a history of sinusitis.
- Early diagnosis and aggressive treatment, including surgical drainage, are paramount for successful outcomes.