Escherichia colipositive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma

Abstract

SUMMARYInfratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature. BACKGROUND

Colesteatoma complicado en un niño con síndrome de Down: un caso clínico

“…7 El síntoma principal inicial es la otorrea fétida crónica con pérdida auditiva. 1,8 Su origen es multifactorial. 2,9 Los pacientes con síndrome de Down tienen una prevalencia elevada (> 80 %) de otitis media con efusión, que puede estar determinada anatómicamente por la hipoplasia mediofacial con una nasofaringe estrecha y adenoides hipertrófica, junto a trastornos funcionales y mecánicos de la trompa auditiva.…”

Posterior Fossa Subdural Empyema. A Severe and Usually Late Diagnosed Complication

“…Tympanomastoidectomy in an acute inflammatory phase is associated with higher bleeding and risk to facial nerve injury. 16 For this reason, SEmp shall be emergently evacuated and focus control shall be performed soon after reuniting the proper conditions -stabilized patient, otolaryngology support, facial nerve monitoring, neuronavigation, proper microscope. This conduct was also described by Zanetti and Nassif 17 in pediatric population.…”

Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist

“…Although often slowly destructive, such a cholesteatoma can become acutely infected and associated with mastoiditis. 4 An example is shown in Figure 3.

Fig.

…”