Sterile Subdural Empyema Mimicking Subdural Hemorrhage in Pediatric patient with History of Trauma

Abstract

Intracranial subdural empyema (SDE) is a life-threatening infection. Surgery procedure for culture the empyema is essential to diagnosing and treating the patient. Nevertheless, in rare cases, culture can not identify the causative organism because microorganisms are not grown. A ten-year-old girl with the main complaint of weakness in the right hand since two days before admission. She fell off the bicycle two months before admission, and her head hit the ground. Nevertheless, the patient's condition was stable at that time, and there was no history of loss of consciousness. A head CT scan with and without contrast found a mass suggesting chronic subdural hemorrhage. The patient undergoes surgery with burr hole drainage for chronic SDH but intraoperatively found subdural empyema. SDE could be an uncommon, harmful, pus-filled accumulation of tissue between the outer dura and inner arachnoid mater. Meningitis is the most frequent cause of SDE in children and newborns. Despite the fact that operative cultures can identify the responsible organisms, 7% to 52% of instances result in no growth, which is primarily due to the use of antibiotics in the past or inappropriate anaerobic culture technique. Intracranial subdural empyema (SDE) is an emergency and life-threatening infection. SDE can also mimic chronic SDH and make it difficult to diagnose. Emergency surgery is required for a better outcome for the patient. Culture empyema from collecting pus is not always found in the microorganism pathogen, which could be in sterile conditions.