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[Subdural empyema as a complication of sinusitis. Association with Streptococcus milleri]
G Plaza Mayor1, C Pérez Martínez, J Martínez San Millán
1Departamento de ORL, Hospital Ramón y Cajal, Madrid.
Abstract:
Intracranial complications of sinusitis now are unusual and subdural empyema is even more infrequent. Furthermore, subdural empyema usually is related to sinus infections, particularly those caused by Streptococcus milleri, an anaerobic organism. Although clinical suspicion is fundamental, computed tomography and magnetic resonance imaging are essential for discovering these complications. These studies enable early diagnosis and prompt treatment, thus reducing the high mortality of this disease. We report two cases of subdural empyema secondary to sinusitis in persons without impaired immunity. Streptococcus milleri was isolated in one of them. A review of the literature disclosed that this is the most frequently involved organism, so the empirical selection of antibiotics targeted this organism.
Insights
Subdural empyema, a rare intracranial complication of sinusitis, is often caused by Streptococcus milleri. Early diagnosis with advanced imaging and targeted antibiotics are crucial for reducing mortality.
Area of Science:
- Neurology
- Infectious Diseases
- Otolaryngology
Background:
- Intracranial complications of sinusitis are rare.
- Subdural empyema (SE) is an infrequent complication, typically linked to sinus infections.
Observation:
- Two cases of SE secondary to sinusitis in immunocompetent individuals are presented.
- Streptococcus milleri, an anaerobic organism, was isolated in one case and is frequently implicated in the literature.
Findings:
- Computed tomography (CT) and magnetic resonance imaging (MRI) are vital for diagnosing SE.
- Prompt diagnosis and treatment are essential for managing this serious condition.
Implications:
- The findings underscore the importance of considering SE in sinusitis patients.
- Empirical antibiotic selection should target Streptococcus milleri due to its prevalence.
- Advanced neuroimaging plays a critical role in early detection and improved patient outcomes.