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Giant subdural empyema in a child: a case report
Tufan Hicdonmez1, Bilge Cakir, M Kemal Hamamcioglu
1Department of Neurosurgery, Trakya University Faculty of Medicine, Edirne 22030, Turkey. tufanhicdonmez@yahoo.com
Surgical Neurology
|December 6, 2006
Summary
A rare, giant Streptococcus pneumoniae subdural empyema (SDE) in a child mimicked an intra-axial lesion. Coronal MRI proved superior to CT for diagnosis, and clinical recovery surpassed imaging improvements.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Neuroradiology
Background:
- Subdural empyema (SDE) is a serious intracranial infection.
- Giant SDEs are rare and can present diagnostic challenges.
Observation:
- A case of an 8 x 6 x 6 cm frontoparietal SDE caused by Streptococcus pneumoniae in a 17-month-old child.
- Initial diagnosis was made via emergency CT scan.
- Surgical drainage of purulent material was performed via frontoparietal craniotomy.
Findings:
- Postoperative MRI demonstrated gradual lesion size reduction.
- Persistent findings included a collapsed capsule, meningeal thickening, and brain displacement.
- The child remained symptom-free at 15-month follow-up.
Implications:
- Giant SDEs can mimic intra-axial brain lesions.
- Coronal MRI is more reliable than axial CT for diagnosing giant SDEs in the upper convexity.
- Clinical improvement can be more significant than radiological changes in SDE management.
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