Infratentorial subdural empyemas mimicking pyogenic meningitis

Abstract

Infratentorial subdural empyema is an extremely rare condition which unfortunately mimics pyogenic meningitis in 75% of cases. While an ill-planned lumbar puncture in these cases may be fatal, an inadvertent delay in treatment may be detrimental to the outcome for the patient. We present a case of a young boy with long standing history of chronic suppurative otitis media (CSOM) presenting with an infratentorial empyema with features suggestive of pyogenic meningitis. We also review the available literature to further define the condition in terms of clinical features, treatment options, and outcome. A misdiagnosis of this condition with failure to institute appropriate surgical intervention and antibiotic therapy is potentially life threatening. We highlight this rare condition which requires a high degree of suspicion especially in the presence of associated risk factors.

Surgical Management of a Pediatric Infratentorial Subdural Empyema as a Complication of Parapharyngeal Abscess

“…Further, five case reports described good recovery in children with infratentorial subdural empyema. In almost all cases, empyema occurred secondary to a middle ear infection [6,[10][11][12].…”

“…Their rarity, nonspecific symptoms, and the need for advanced radiological imaging make this pathology prone to delayed diagnosis [4][5][6]. Delayed treatment has been associated with high morbidity and mortality [7].…”

“…Delayed treatment has been associated with high morbidity and mortality [7]. Hence, prompt diagnosis and immediate surgical evacuation combined with intravenous antibiotic therapy are of utmost importance [4,[6][7][8]. The literature on infratentorial subdural empyema is scarce.…”

Pediatric infratentorial subdural empyema: A case report

“…Sengul[ 12 ] reports one such case in a 15-year-old boy, whereas Gupta et al . [ 4 ] reported a case of 17-year-old patient. In both studies, the empyema followed a middle ear infection and presented mimicking pyogenic meningitis.…”

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“…Craniectomy is a method of treatment applied to remove the effect of edema on the brain stem and the fourth ventricle and subsequently decrease hydrocephalus. [6,7,15,16] However, the dura membrane must be open for complete cerebellar decompression. Therefore, this procedure may lead to meningitis in patients due to contamination of the CSF.…”