Giant hemicranial calcified subdural empyema — unusual complication following ventriculoperitoneal shunt insertion

Kasliwal, Manish K.; Sinha, Sumit; Kumar, Rajinder; Sharma, Bhawani S.

doi:10.1007/s12098-009-0162-6

Cited by 7 publications

(10 citation statements)

References 6 publications

(7 reference statements)

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“…[ 3 ] Furthermore, a cranial neurosurgical procedure (ventricular shunting or subdural drain placement) may seed bacteria in the subdural space or prompt a secondary infection of a distant subdural effusion. [ 6 16 ]…”

Section: Discussionmentioning

confidence: 99%

Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication

2016

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Background:Surgery is routinely recommended for lumbar lipomyelomeningocele, especially in the setting of tethered cord syndrome. The most common complications are wound infections and cerebrospinal fluid (CSF) leak, which remain confined to the surgical site. To the best of our knowledge, there have been no prior reports relating an intracranial subdural empyema following detethering surgery. Prompt diagnosis is essential since subdural empyema is a neurosurgical emergency.Case Description:The patient was an 11-month-old male who underwent detethering surgery for a lumbar lipomyelomeningocele. This was followed by wound drainage consistent with CSF leak, requiring revision. Cultures grew three aerobes (Escherichia coli, Enterococcus, and Klebsiella) and three anaerobes (Clostridium, Veillonella, and Bacteroides). He was started on cefepime, vancomycin, and flagyl. The patient required two more wound revisions and placement of an external ventricular drain (EVD) secondary to persistent wound leakage. A subsequent magnetic resonance imaging (MRI) brain was carried out due to protracted irritability, which revealed extensive left subdural empyema along the parietooccipital region and the inferior and anterior temporal lobe. He underwent evacuation of the subdural empyema where cultures exhibited no growth. Subsequently, he progressed well. His lumbar incision continued to heal. Serial MRI brains and inflammatory markers were reassuring. He weaned off his EVD and went home to complete a 6-week course of antibiotics. Upon completion of his antibiotics, he returned for a clinic visit; he exhibited no interim fevers or wound issues; cranial imaging documented no evidence of a residual or recurrent subdural empyema.Conclusion:Intracranial subdural empyema may occur after wound complications from detethering surgery despite early initiation of broad-spectrum antibiotics. Possible etiology may be local wound infection that seeds the subdural space and travels to the cranium, leading to meningitis and subdural empyema. Such a scenario should prompt surveillance imaging of the head as undiagnosed subdural empyema may lead to devastating consequences.

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Section: Discussionmentioning

confidence: 99%

Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication

2016

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“…A sinus infection may seed through valveless veins communicating between extracranial and intracranial structures; on the other hand, a neurosurgical procedure may introduce direct bacterial contamination of the subdural space or lead to secondary infection of a remote subdural effusion, both routes that ultimately lead to a subdural empyema. [ 3 8 ] Our patient had four neurosurgical procedures: The placement of a right frontal EVD, the posterior fossa craniotomy for resection of the medulloblastoma, the placement of a right occipital VP shunt, and the diagnostic lumbar puncture. After removal of the EVD and placement of the shunt, a minor subdural hygroma developed.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, a shunted patient was reported to have a subdural empyema undiagnosed and untreated for up to 9 years due to the lack of MRI and as a result, the patient suffered significant neurological injury. [ 8 ] In this case, the radiologist reports a subacute on chronic right frontal subdural hematoma from the CT head on the day of admission [ Figure 1d ]. Therefore, relying on CT head alone, at least in this case, would miss the diagnosis of subdural empyema altogether, putting the patient at a higher risk of neurological injuries.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, only 3 case reports have documented this association while another two patients are briefly mentioned in case series. [ 1 3 7 8 12 ] All reports concern the pediatric population. Herein, the authors describe the first adult patient who developed a subdural empyema from a preexisting hygroma shortly after placement of a VP shunt.…”

Section: Introductionmentioning

confidence: 99%

“…A shunted patient was reported to have a subdural empyema undiagnosed and untreated for up to 9 years due to the lack of magnetic resonance imaging (MRI) and as a result, the patient suffered significant neurological injury. [ 8 ] The authors emphasize vigilance for this rare pathology in patients with existing VP shunts and advise a lower threshold for MRI. A prompt diagnosis of a subdural empyema offers the advantage of draining the infection and externalization of the infected shunt in the same operation, saving time, and money while giving the patient the best chance of recovery.…”

Section: Introductionmentioning

confidence: 99%

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Co-presentation of a subdural empyema and an infected ventriculoperitoneal shunt in an adult patient: A rare complication with review of literature

et al. 2015

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Background:The occurrence of a subdural empyema as a complication of a ventriculoperitoneal (VP) shunt infection is rare. Only three articles have been published on this topic. Moreover, the available literature only involves pediatric patients.Case Description:The authors present a 38-year-old male with a preexisting right frontal subdural hygroma that developed into a subdural empyema in the presence of an infected right occipital VP shunt. A brief literature review is provided, and the pathogenesis is discussed.Conclusion:This is the first known report regarding an adult patient with a subdural empyema and a VP shunt infection. Although a magnetic resonance imaging (MRI) brain is not typically ordered during diagnosis of a shunt infection, the authors advocate a low threshold to employ MRI brain to evaluate for other sources of infection, especially in an immunocompromised patient or in a patient with a history of a subdural hematoma or hygroma that can be easily overlook as being stable on computed tomography of head.

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Subdural Collections: Hygroma and Haematoma

Gelabert-González¹,

Arán-Echabe²,

Serramito-García³

2014

Complications of CSF Shunting in Hydrocephalus

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Giant hemicranial calcified subdural empyema — unusual complication following ventriculoperitoneal shunt insertion

Cited by 7 publications

References 6 publications

Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication

Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication

Co-presentation of a subdural empyema and an infected ventriculoperitoneal shunt in an adult patient: A rare complication with review of literature

Subdural Collections: Hygroma and Haematoma

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