[Subdural empyema: medical treatment]

A young man who initially presented right maxillary sinusopathy which was treated with antibiotics, developed meningeal syndrome in association with focal neurological signs followed by focal tonoclonic convulsions which subsequently became general. Computed tomography confirmed the presence of a left parasagittal and right frontal subdural empyema. Medical treatment with antibiotics, dexamethasone and anticonvulsants resulted in rapid clinical and radiologic improvement in both the sinuses and brain images. The diagnostic and therapeutic aspects are discussed and medical treatment recommended as the first step in the therapy of subdural empyema when there is no other critical neurological situation.