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[Subdural empyema complicating sinusitis]
E Saiag1, D Steir, M Michowitz
1Medical Corps, Israel Defence Forces.
Abstract:
Paranasal sinusitis complicated by subdural empyema (SDE) in a 14-year-old boy is described. He presented with fever, headache and vomiting. X-rays revealed left maxillary and bilateral frontal sinusitis. While in the emergency room he had seizures; CT-scan showed an air leak adjacent to the right frontal sinus. Despite intravenous antibiotics, left hemiparesis developed and repeat CT showed interhemispheric SDE. Frontal craniotomy was performed and a large amount of purulent material was drained. Recovery followed 4 weeks of intravenous antibiotic treatment without neurologic sequelae. SDE is a rare complication of paranasal sinusitis and constitutes approximately 20% of all localized intracranial infections. Clinical features include fever, headache, vomiting, convulsions and neurologic deficits. Modern imaging methods and combined surgical and antibiotic treatment have lowered mortality to 5-10%. A high index of suspicion is important for early diagnosis and successful treatment.
Insights
A rare case of subdural empyema (SDE) in a boy with paranasal sinusitis highlights the importance of early diagnosis. Prompt surgical drainage and antibiotics led to a full recovery without lasting neurological issues.
Area of Science:
- Neurology
- Infectious Diseases
- Otolaryngology
Background:
- Subdural empyema (SDE) is a rare but serious complication of paranasal sinusitis, accounting for approximately 20% of localized intracranial infections.
- Early recognition and prompt intervention are crucial for favorable outcomes.
Observation:
- A 14-year-old boy presented with symptoms including fever, headache, vomiting, and seizures, indicative of complicated sinusitis.
- Imaging revealed paranasal sinusitis with an air leak and subsequently, an interhemispheric subdural empyema.
- The patient developed left hemiparesis despite initial antibiotic treatment.
Findings:
- Surgical intervention via frontal craniotomy successfully drained a large purulent collection.
- A 4-week course of intravenous antibiotics facilitated complete recovery without neurological sequelae.
- This case underscores the effectiveness of combined surgical and antibiotic management.
Implications:
- A high index of suspicion for SDE in patients with sinusitis and neurological symptoms is essential for timely diagnosis.
- Modern diagnostic tools and aggressive treatment strategies have significantly reduced mortality rates for SDE to 5-10%.
- Prompt management can prevent long-term neurological deficits associated with intracranial infections originating from paranasal sinuses.