Bilateral epidural empyemas in an adolescent

Area of Science:

• Neurology
• Infectious Diseases
• Emergency Medicine

Background:

• Epidural empyema is a rare but serious condition involving pus collection between the dura mater and the skull.
• It often arises from the contiguous spread of infections, most commonly sinusitis.
• Nonspecific symptoms like headache, fever, and elevated white blood cell count can mask this diagnosis.

Observation:

• A case report details an adolescent presenting with persistent headache over six days.
• Initial presentation was nonspecific, delaying diagnosis.
• A second emergency department visit prompted imaging revealing bilateral epidural empyema.

Findings:

• Cranial computed tomography (CT) is essential for diagnosing epidural empyema.
• The study highlights that epidural empyema can present without focal neurological deficits.
• This emphasizes the importance of considering this diagnosis even with vague symptoms.

Implications:

• Emergency physicians must maintain a high index of suspicion for epidural empyema in patients with persistent, severe headaches.
• Prompt recognition and imaging are critical for timely intervention and preventing complications.
• This case underscores the diagnostic challenges and potential severity of epidural empyema.