Cranio-spinal subdural empyema due to S. intermedius: a case report
Angelo Pompucci1, Pasquale De Bonis, Giovanni Sabatino
1Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Background And Purpose:
Subdural empyema represents a loculated infection between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. While treatment guidelines for a single (either brain or spinal) localization of a subdural empyema are more or less established, its management when a massive involvement of CNS is evident represents a challenge.
Methods:
The authors describe a unique case of a 65-year-old woman having a massive involvement of the entire CNS with multiple localizations, both intracranial and spinal. Early diagnosis was obtained through brain CT scans followed by cranio-spinal contrast enhanced MRI scans. Patient was treated with external ventricular drainage and suboccipital craniectomy, while on antibiotic therapy.
Results:
Patient's neurological condition gradually improved. By the end of the eighth hospital week, she was discharged without any neurological deficit.
Conclusions:
Spinal subdural empyema and brain subdural empyema are not always, as in our case, two different entities. Prompt diagnosis and treatment constitute the major variables affecting outcome.
Insights
This study presents a rare case of extensive central nervous system (CNS) subdural empyema, affecting both the brain and spine. Prompt diagnosis and surgical intervention led to a full neurological recovery, highlighting the importance of timely management for this challenging condition.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Subdural empyema (SE) is a rare infection between the dura and arachnoid layers.
- While intracranial and spinal SE are known, simultaneous massive central nervous system (CNS) involvement is exceptionally rare and poses management challenges.
Observation:
- A 65-year-old woman presented with extensive intracranial and spinal subdural empyema.
- Diagnosis was established using CT and contrast-enhanced MRI of the cranio-spinal axis.
Findings:
- The patient underwent external ventricular drainage, suboccipital craniectomy, and antibiotic therapy.
- Neurological status progressively improved, with complete recovery and discharge after eight weeks.
Implications:
- This case suggests that spinal and brain subdural empyema can be manifestations of a single, widespread CNS infection.
- Aggressive and prompt diagnosis and treatment are critical for favorable outcomes in complex subdural empyema cases.
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