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Subdural Empyema Complicating Bacterial Meningitis: A Challenging Diagnosis in a Patient with Polysubstance Abuse

Melissa Dakkak1, William Russell Cullinane1, Virin Rajiv Neil Ramoutar1

  • 1Department of Medicine, University of Florida, 653 W. 8th Street, Box L18, Jacksonville, FL 32209, USA.

Case Reports in Medicine
|November 7, 2015
PubMed

Insights

Bacterial meningitis can cause rare, severe complications like subdural empyema and stroke. Early detection of focal deficits is crucial for timely neurosurgical intervention and improved patient outcomes.

Area of Science:

  • Neurology
  • Neurosurgery
  • Infectious Diseases

Background:

  • Bacterial meningitis can lead to severe complications including subdural empyema (SDE) and cerebrovascular accident (CVA).
  • These complications are uncommon but life-threatening, necessitating prompt neurosurgical intervention.
  • Early recognition of focal neurologic deficits or seizures is key for diagnosing SDE.

Purpose of the Study:

  • To report a challenging case of community-acquired pneumococcal meningitis.
  • To highlight the diagnostic complexities of SDE with vasculitis-induced CVA.
  • To emphasize the impact of confounding factors like substance abuse and sedation on diagnosis.

Main Methods:

  • Case report presentation.
  • Clinical assessment and diagnostic workup for meningitis complications.
  • Review of literature regarding SDE, CVA, and Streptococcus pneumoniae.

Main Results:

  • The case involved Streptococcus pneumoniae meningitis, a rare cause of pyogenic brain abscesses.
  • The patient presented with SDE and vasculitis-induced CVA.
  • Diagnosis was complicated by concurrent substance abuse and sedation.

Conclusions:

  • Vigilance for SDE and CVA in bacterial meningitis is critical.
  • Confounding factors can significantly obscure the diagnosis of these neurosurgical emergencies.
  • Prompt diagnosis and intervention are vital to prevent adverse outcomes in meningitis complications.

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