Traumatic brain injury (TBI) following increased intracranial pressure (ICP) is a neuroemergency case which should be managed promptly to prevent secondary brain injury. This will lead to a condition called cerebral energy dysfunction which is an important determinant factor toward worse outcome. Lactate, which was historically known as an end waste product, now is considered as an alternative cerebral energetic fuel. Hypertonic sodium lactate (HSL) is a promising hyperosmolar fluid which serves not only to decrease ICP but also to readily supply exogenous lactate to fulfill increased cerebral energy demand. Pioneer studies have shown the harmlessness and usefulness of HSL in treating pathological condition including TBI.

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.

Traumatic Brain Injury (TBI) case is commonly found in the emergency room. TBI accompanied by increased intracranial pressure (ICP) is a neurological emergency that requires prompt and appropriate management. Hyperosmolar fluid is the main treatment in the initial management of increased ICP. Mannitol and hypertonic saline are hyperosmolar fluids which are generally used. There is no specific recommendation regarding the choice between the two fluids. From the current studies indicate that both fluids are equally effective in reducing ICP. Regarding the superiority between the two fluids, it is difficult to determine because of the heterogeneity of the studies that exist. Therefore, clinicians should choose between hyperosmolar fluids based on indications and contraindications exist in TBI patients.