[A case of subdural empyema with hemorrhage]

A rare case of subdural empyema accompanied by hemorrhage in a 2-year-old boy is reported. The patient was hospitalized on May 31, 1995 because of high fever. Lumbar puncture was performed, a diagnosis of suppurative meningitis was made, and streptococcus pneumoniae was cultured from the CSF. The next day, the patient experienced convulsions, and CT scans revealed left subdural empyema. Intensive antibiotic therapy was performed for 16 days from the onset of symptoms, but the patient's fever persisted, and the area of subdural empyema had grown larger on CT scan on June 15th. He was transferred to our institution the same day. Enhanced MRI clearly showed the capsule of the empyema in the left subdural space. Evacuation of the empyema and irrigation of the cavity were performed via a single burr hole. The old bloody fluid was found to be accompanied by a yellowish-white abscess in the subdural space. We concluded that the source of the bleeding was probably the fragile vessels in the capsule. The patient recovered after surgical treatment and a prolonged course of antibiotic therapy.