Infantile Chronic Subdural Hematoma Infected by Escherichia Coli -Case Report-

Abstract

A 6-month-old boy presented with a rare case of infected subdural hemorrhage manifesting as sustained fever and focal seizure. The boy had been well without contributory medical history. Physical examination found no neurological impairment with intact superficial appearance and soft fontanels. The parents denied recent head trauma or shaking injury. Blood examination was normal except for white blood cell count of 19200/ml and C-reactive protein level of 6.7 mg/dl. Bacterial culture of nasal swab, urine, stool, and venous blood samples was negative. Cerebrospinal fluid examination showed normal findings. Cranial computed tomography revealed an expansive subdural fluid collection in the right frontotemporal region. Magnetic resonance imaging showed the lesion as hypointense on T1-and hyperintense on T2-weighted images with intense enhancement of the outer membrane. The patient underwent burr-hole drainage, which identified the subdural hematoma encapsulated in a thick outer membrane and intermingled with pus material. Culture of the pus identified Escherichia coli. The patient received antibiotic therapy for 8 weeks that resulted in complete resolution of the infection. We assumed that preexisting subdural hematoma formed after minor head trauma was followed by hematogenous infection by E. coli. Infected subdural hematoma is possible in infants presenting with subdural hemorrhage with clinical symptoms of bacteremia.

Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review

“… 20 The limited understanding of E. coli infection is apparent in bacterial meningitis in infants where the predisposing factors were not identified in 70% of patients. 21 In our case, no extracranial infective focus was identified.…”

“… 13 14 28 Burr hole drainage alone has been shown to be sufficient for the complete drainage of subdural empyema. 13 21 However, some found that the success rate with craniotomy was superior over burr holes and associated with a lower mortality rate. 8 17 Furthermore, in one study burr hole evacuation of pus resulted in a 40% recurrence.…”

Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

“…The incidence of infected subdural hematoma is quite low, and only 27 cases have been reported in the literature (table 1 ) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Although subdural empyema occurs mainly due to the spread of infectious focus near the cranium, infected subdural hematoma most likely occurs through a hematogenous infection to a preceding chronic subdural hematoma [ 14 , 18 ].…”

“…A preexisting subdural hematoma may transform to an infected subdural hematoma mainly through hematogenous infection. According to previous reports, the phlogogenic fungus of an infected subdural hematoma widely varies, including Escherichia coli , Klebsiella , Salmonella and Methicillin-resistant Staphylococcus aureus (MRSA) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In this report, we present an adult case that developed chronic subdural hematoma infected by Propionibacterium acnes .…”

Complications of Purulent Meningoencephalitis in Children

“…Из осложнений, требующих наблюдения нейрохирурга, наиболее важными являются гидроцефалия и развитие хронических субдуральных гематом. Нейроинфекция часто является причиной развития хронических субдуральных гематом [3,8,9,11], наиболее характерной в раннем детском возрасте [1]. В некоторых литературных источниках сообщается о «субдуральном выпоте», обнаруживаемом в 25-50% неонатальных менингитов, которые часто встречаются при инфекционном поражении, вызванном гемофильной палочкой [5].…”