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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
PubMed

Insights

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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