Interhemispheric Subdural Empyema Secondary to Sinusitis in an Adolescent Girl

Shen, Yali; Cheng, Zhi-Juan; Chai, Jingyan; Dai, Tingmin; Luo, Ying; Guan, Yanqin; Nie, Hongbing

doi:10.4103/0366-6999.247213

Cited by 8 publications

(7 citation statements)

References 5 publications

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“…Intracranial complications of orbital cellulitis and para-nasal sinusitis including epidural abscess, SDE, intracranial or cerebral abscess, meningitis, and encephalitis [ 13 ]. Microorganisms invade through para-nasal sinuses and orbital cavity to the brain via two pathway; first, direct invasion by the existing micro-perforation or dehiscence and erosion of bony wall, and second; spreading to leptomeninges through communicating valve less veins [ 13 , 41 ]. Extension of infection through the posterior wall of the frontal sinus is the most common pathway leading to subdural or epidural abscess formation [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Abtahi

Eghtedari

Hosseini

et al. 2020

J Ophthal Inflamm Infect

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Background: Orbital cellulitis is an ophthalmic emergency, which is associated with vision-threatening adverse effects. The purpose of this study is investigating etiology, radiologic findings, management and complications of patients with non-medial orbital cellulitis. Method: A retrospective medical record and radiologic file review of patients with infectious orbital cellulitis was performed to detect all patients with non-medial orbital cellulitis who referred to Khalili hospital from 2016 to 2019. Age, sex, origin of infection, size of collection or abscess, medical or surgical management, microbiology, first and final best-corrected visual acuity, duration of admission, and complications was recorded. Patients divided into two groups; medical management and surgical management groups and all of data compared between in this groups. Results: Of ninety-six patients with infectious orbital cellulitis, 23 cases (14 male, 9 female) were included. Five patients (21.7%) were managed medically and 18 patients (78.3%) were managed surgically. Patients' age range was 5-70 years old. Most common location for non-medial cellulitis was superior space (66.7% in surgical and 40% in medical group; p = 0.511). In 13 cases of surgical group (72.3%) were detected microorganisms. The mean ± SD of collection volume in medical group were 476.5 ± 290.93 mm 3 and 2572.94 ± 1075.75 mm 3 in surgical group (p < 0.001). Ten patients in surgical group had compressive optic neuropathy. The mean ± SD of collection volume was 3204.97 ± 879.88 mm 3 in patient with compressive optic neuropathy and 1280.43 ± 880.68 mm 3 in patient without compressive optic neuropathy (P < 0.001). One case complicated by subdural empyema and another case progressed to necrotizing fasciitis. Conclusion: Non-medial orbital cellulitis is an uncommon but sight-threatening and life-threatening condition. Timely diagnosis and accurate management reduce morbidity and mortality. Combined surgery for patients with superior or supra-temporal and large non-medial abscess is recommended.

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Section: Discussionmentioning

confidence: 99%

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Abtahi

Eghtedari

Hosseini

et al. 2020

J Ophthal Inflamm Infect

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“…5,6 Overall, this patient could present alterations of consciousness, seizures, meningeal irritation, and nonspecific symptoms such as fever, headache, and purulent rhinorrhea. 7,8 The treatment of a subdural empyema consists of three points: surgical evacuation of pus, eradication of the primary foci of infection, and adequate antibiotic therapy. Craniectomy plus evacuation of the empyema and fibrinoid material were performed in this patient (it ensures maximal drainage of the loculated pus and allows the total removal of the infected hematoma capsule).…”

Section: Discussionmentioning

confidence: 99%

Subdural Empyema by Enterobacter cloacae: Case Report

Celi

Saal‐Zapata

2020

Indian Journal of Neurotrauma

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Infections of the central nervous system are a medical emergency, potentially lethal and associated with increased morbidity and mortality. We present the case of a male with risk factors and clinical deterioration, in which the brain computed tomography scan showed a subdural collection following a head injury, which underwent surgical evacuation revealing a subdural empyema. The culture of the subdural collection yielded a positive result to Enterobacter cloacae.

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

Section: Discussionmentioning

confidence: 99%

“…A thorough review of the literature yielded 31 well-detailed case reports of parafalcine SDEs [Table 1]. [1-3,5,6,8-11,13-17,19,23-27,29,31,35] Treatment strategies and outcomes of these cases and our own are discussed.…”

Section: Introductionmentioning

confidence: 99%

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

Prieto

Ortega

2019

Surgical Neurology International

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Background: Parafalcine subdural empyema (SDE) is a rare entity consisting of pus accumulating below the longitudinal sinus, between the falx cerebri and the arachnoid layer covering the medial surface of the cerebral hemisphere. Its treatment strategy is controversial, but most clinicians have the general belief that appropriate treatment consists of prompt surgery combined with long-term antibiotic therapy. Nevertheless, six reports published in the 1980s provided evidence that antibiotic therapy alone is a safe and suitable option. The treatment strategies and outcomes of the 31 well-described cases previously published, in addition to our own, are discussed. Case Description: We report a 21-year-old female with a right-side parafalcine SDE who presented with fever, headache, generalized tonic-clonic seizures, and contralateral hemiparesis 3 weeks after undergoing sinonasal surgery. Despite clinical symptoms almost entirely abating after starting treatment with broad-spectrum antibiotics, magnetic resonance imaging performed during the 2nd and 3rd weeks showed progressive enlargement of the interhemispheric collection (from 4 cm3 to 30 cm3). We reflect on the treatment strategy chosen for this patient, who experienced a total recovery. Conclusion: A nonsurgical strategy for parafalcine SDE might be contemplated for patients with a good clinical condition and no major midline shift on neuroradiological studies, given their usual indolent course and the relative difficulty in reaching the interhemispheric fissure. Conversely, surgery should be contemplated when the collection significantly enlarges despite antibiotic therapy. When surgical drainage is added to antibiotics, broad- range 16S ribosomal DNA polymerase chain reaction of the empyema is recommended to identify the causative organism as pus cultures are usually sterile.

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Interhemispheric Subdural Empyema Secondary to Sinusitis in an Adolescent Girl

Cited by 8 publications

References 5 publications

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Non-medial infectious orbital cellulitis: etiology, causative organisms, radiologic findings, management and complications

Subdural Empyema by Enterobacter cloacae: Case Report

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

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