Pediatric infratentorial subdural empyema: A case report

Abstract

Background:Infratentorial subdural empyemas in children are extremely rare and potentially lethal intracranial infections. Delay in diagnosis and therapy is associated with increased morbidity and mortality.Case Description:A 4-year-old boy presented with cerebellar signs following a failed treatment of otitis media. Imaging studies revealed a subdural empyema and left transverse and sigmoid sinus thrombosis. The empyema was evacuated operatively and antibiotic treatment was initiated and administered for 6 weeks. The patient recovered fully and was discharged 4 weeks following the evacuation of the empyema.Conclusion:While prompt identification and treatment of subdural infratentorial empyemas are crucial for favorable outcomes, their diagnosis in children might be initially missed. This is, in part because they are so rare and in part, because imaging artifacts arising from the complex posterior fossa anatomy may obscure their presence in the computer tomography (CT) scan. Therefore, high level of suspicion is necessary, given the appropriate history and clinical presentation. In children, this is a recent history of protracted otitis media and central nervous system symptomatology—cerebellar or other.

A Case of Subdural Empyema Due to Dental Pathogen

“…A sample of the abscess/empyema was taken to guide the antibiotic therapy; however, no organism grew in the medium. The literature states that seven percent to 53 percent of patients’ cultures are negative [ 3 , 4 ]. Sterile empyema might be due to early administration of antibiotics or improper use of culture medium.…”

“…Still, an empiric regimen against staphylococcus , streptococcus , anaerobes, and gram-negative bacilli must be provided (metronidazole and ceftriaxone or cefotaxime which can enter the cerebrospinal fluid). Furthermore, anti-epileptic drugs should be given in view of the high incidence of perioperative seizures and steroids to decrease inflammation and cerebral edema [ 1 , 3 , 5 ]. As seen in our case, if SE is due to tooth infection, experts believe dental extraction may be required in addition to antibiotics [ 10 ].…”

“…Early recognition, intravenous antibiotics, and timely surgical intervention significantly decrease morbidity and mortality [ 3 , 4 ]. Through this case report, the team intends to educate and create awareness of SE, an infection that warrants early medical and surgical intervention.…”

“…It can also be classified as a brain abscess. According to the literature, 40%-80% of SE cases have otorhinology infection, 20% of cases occur following head trauma or cranial surgical procedures, and others rarely have a blood infection [1][2][3]. The most common organisms found in abscesses/empyemas are anaerobes such as Streptococci, Staphylococcus, and Haemophilus influenzae.…”