Interhemispheric and Infratentorial Subdural Empyema with Preseptal Cellulitis as Complications of Sinusitis: A Case Report

Abstract

Intracranial complications of paranasal sinusitis have become rare due to the use of antibiotics nowadays. However, several cases have been reported due the ability of paranasal sinusitis to cause serious complications. Once the infection spreads over the cranial structure, it could infect the orbits, underlying bones, meninges, adjacent veins, and brain. Subdural empyema is a rare but potentially life-threatening complication following paranasal sinusitis and should be considered as a neurological emergency. The location where subdural empyema may appear is a challenge in diagnosis and treatment. We report the case of a 17-year-old boy who presented in a state of somnolence due to interhemispheric and infratentorial subdural empyema with preseptal cellulitis secondary to pansinusitis. Early diagnosis and aggressive antibiotic treatment combined with neurosurgical operation were mandatorily implemented. The case was managed using a multidisciplinary approach including the ENT, eye, and nutrition departments. The boy achieved clinical improvement, with impairment of eye movement as the only persistent symptom before discharge. Daily supervision at the primary health care center with continuous antibiotic treatment was recommended to the patient. Pertinent literature with controversies in the management of subdural empyema will be briefly discussed in this case report.

Subdural empyema due to mixed infections successfully treated medically: A case report with review literature

“…21 SDE had reported getting negative in culture test; a case series by Madhugiri et al consisting of 27 patients with a mean age of 10 years reported that 26% of patients get negative in culture test. 20 Based on our case, physicians should consider the treatment of viral and bacterial infections in similar circumstances. Medical treatment of mild SDE patients can be effective and safe.…”

“…They increased a Glasgow coma scale from 8/15 to 15/15 with no seizures 21 . SDE had reported getting negative in culture test; a case series by Madhugiri et al consisting of 27 patients with a mean age of 10 years reported that 26% of patients get negative in culture test 20 …”

Subdural empyema due to mixed infections successfully treated medically: a case report with review literature.

“…Musa et al reported evidence of pre-surgical treatment with I.V chloramphenicol and metronidazole for four weeks and resulted in an increase in a Glasgow coma scale from 8/15 to 15/15 with no seizures (23). Subdural empyema had reported getting negative in culture test; a case series by Madhugiri et al consisted of 27 patients with a mean age of 10 years reported that 26% of patients get negative in culture test (22).…”

Parafalcine subdural empyema: The unresolved controversy over the need for surgical treatment

“…[20] In the present series of 32 parafalcine SDEs, only 2 cases experienced rapid neurological deterioration (cases 29 and 31). [2,29]…”