Subdural Empyema Secondary to Severe Paranasal Sinusitis

A 59-year-old female presented to the emergency department with an acute onset of unilateral facial droop and aphasia. Collateral information obtained from her family revealed a diagnosis of prolonged subacute bacterial sinusitis with initiation of multiple antimicrobial regimens. The patient underwent a non-contrast computed tomography of the brain, which demonstrated a 1.2-cm lobulated extra-axial collection overlying the left frontotemporal region with an associated midline shift consistent with subdural empyema. The patient was initiated on intravenous antibiotics and underwent emergent burr hole placement with successful evacuation of the subdural empyema. Additionally, the patient's hospital course consisted of a bilateral maxillary antrostomy, bilateral total sphenoethmoidectomy, and bilateral frontal sinusotomy, septoplasty, as and excision of her right concha bullosa. Subdural empyema is a pyogenic infection of the subdural space located between the dura mater and the arachnoid matter, with high rates of morbidity and mortality. Treatment is based on rapid identification and treatment of the underlying causative factor as well as surgical evacuation to obtain source control.