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Multidisciplinary management and outcome in subdural empyema--a case report
D A Nica1, R Moroti-Constantinescu, R Copaciu
1Neurosurgery Clinic, "Sf. Pantelimon" Clinical Emergency Hospital, Bucharest, Romania. danicaurel@hotmail.com
Chirurgia (Bucharest, Romania : 1990)
|December 15, 2011
Summary
Cranial subdural empyema (SDE) requires prompt recognition and treatment to prevent severe outcomes like coma. This case highlights the importance of early diagnosis and interdisciplinary care for complex SDE complications.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cranial subdural empyema (SDE) is a rare but serious septic intracranial collection, often stemming from infections like sinusitis or otitis.
- Early recognition and prompt neuroimaging are critical for managing SDE, as delays can lead to severe neurological deficits or death.
Observation:
- A young boy presented with symptoms suggestive of SDE, initially showing a thin subdural collection with minimal midline shift.
- Repeated MRI revealed an enlarging subdural collection, significant midline shift, pansinusitis, mastoiditis, and transverse sinus thrombophlebitis, necessitating urgent surgical intervention.
Findings:
- Surgical intervention confirmed the collection as empyema.
- The patient experienced complications including cerebral edema, hemiparesis, secondary epilepsy, and intracerebral cysts requiring further surgery.
Implications:
- This case underscores the necessity of a multidisciplinary approach involving various specialists for optimal management of complex SDE cases.
- Effective treatment requires prolonged antibiotics, epilepsy management, and physical therapy, with potential need for further surgical interventions for residual complications.
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