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The efficacy of MR imaging in subdural empyema
H Komori1, T Takagishi, E Otaki
1Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
Abstract:
MRI findings of a 14-year-old boy with subdural empyema (SE) are reported and compared with those of serial CT-scan. He was admitted with fever, headache, right hemiplegia and facial palsy. Initial enhanced CT-scan revealed a slit left lateral ventricle and a shift in the mid-line structures, but failed to detect any SE. MRI at 10 days after admission clearly demonstrated SE as an area of low intensity on T1-weight (T1WI) and very high intensity on T2-weight (T2WI). Post-contrast enhanced MRI (CE-MRI), using Gd-DTPA, showed a contrast enhancement in the wall of SE. However, no definite parenchymal abnormal intensity areas were detected, suggesting that the diagnosis was made sufficiently early for timely treatment and good neurological outcome. CE-MRI proved to be a more powerful and better diagnostic procedure than enhanced CT-scan, and was very useful in determining the state and development of the disease.
Insights
Magnetic Resonance Imaging (MRI) is superior to CT scans for diagnosing subdural empyema (SE). Early MRI detection in a pediatric case facilitated timely treatment and positive neurological outcomes.
Area of Science:
- Neurology
- Radiology
- Pediatric Imaging
Background:
- Subdural empyema (SE) is a serious intracranial infection.
- Early diagnosis is crucial for favorable neurological outcomes.
- CT scans may not always detect early-stage SE.
Observation:
- A 14-year-old boy presented with symptoms including fever, headache, hemiplegia, and facial palsy.
- Initial CT scans failed to identify SE.
- MRI revealed characteristic low T1 and high T2 signal intensities consistent with SE.
Findings:
- Contrast-enhanced MRI (CE-MRI) demonstrated SE with wall enhancement.
- No significant parenchymal abnormalities were detected on MRI.
- CE-MRI proved more effective than CT for SE diagnosis and monitoring.
Implications:
- Advanced MRI techniques offer superior diagnostic capabilities for SE.
- Early and accurate SE diagnosis via MRI enables prompt intervention.
- This case highlights MRI's value in pediatric neuroimaging for infectious processes.