Subdural Empyema in an Immunocompetent Active Duty Soldier: A Case Report

Intracranial subdural empyema is a rare clinical entity with incidence estimates of 0.1 per 100,000 people. The condition is most often the sequela of a primary infection elsewhere and carries a high morbidity and mortality. The authors present the case of a 22-year-old active duty soldier on mission on the southern border of the United States. The patient had been complaining of headaches that became progressively worse over 2 weeks and presented to a civilian hospital where he was diagnosed with intracranial abscess versus sinus thrombosis on radiographic imaging. The patient was promptly transferred to a military tertiary care center where further workup including pivotal imaging confirmed subdural empyema and right transverse sinus thrombosis. Given the rapid patient deterioration associated with subdural empyema, the emergent intravenous antibiotics, neurosurgical consultation, and subsequent collection evacuation performed are likely to credit for saving this soldier's life. This case highlighted an atypical and time-sensitive etiology for a common complaint in the active duty population, which underscores the requirement for evacuation to higher roles of care in those soldiers with a similar diagnosis.