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Fulminant subdural empyema treated with a wide decompressive craniectomy and continuous irrigation--case report
Yuji Wada1, Takeshi Kubo, Tomoshige Asano
1Department of Neurosurgery, Kenwakai Otemachi Hospital, Kitakyushu, Fukuoka, Japan. ywada-nsu@umin.ac.jp
Neurologia Medico-Chirurgica
|October 10, 2002
Summary
A severe brain infection, subdural empyema, caused by sinus infection was successfully treated. Prompt surgical intervention and continuous irrigation led to patient recovery with minimal neurological deficit.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Subdural empyema is a rare but serious infection in the brain.
- Pansinusitis can lead to intracranial complications like subdural empyema.
- Early diagnosis and intervention are crucial for favorable outcomes.
Observation:
- A 56-year-old male presented with symptoms of rhinorrhea, periorbital cellulitis, fever, convulsions, and altered consciousness.
- Neuroimaging revealed pansinusitis with skull erosion and extensive subdural empyema.
- Cerebrospinal fluid analysis identified Streptococcus milleri as the causative agent.
Findings:
- Surgical management included decompressive craniectomy, empyema irrigation, and subdural drainage.
- Endoscopic sinus surgery addressed the underlying sinusitis.
- Continuous subdural space irrigation with gentamicin-infused saline for seven days effectively cleared pus and debris.
Implications:
- This case highlights the importance of recognizing and treating sinusitis complications promptly.
- Aggressive surgical and antimicrobial strategies can lead to successful outcomes in fulminant subdural empyema.
- Multidisciplinary approaches involving neurosurgery and ENT are vital for managing complex sinogenic intracranial infections.