Subdural empyema due to mixed infections successfully treated medically: A case report with review literature

Abstract

Subdural empyema is a rare intracranial infection with an accumulation of purulent material between the dura and arachnoid matter. We report a case of 17 years old presented with an altered conscious level. CSF analysis showed increased WBCs. His situation has improved after treating by acyclovir, ceftriaxone, vancomycin, and dexamethasone.

Intracranial Infections Arising From an Odontogenic Infection: A Report of 2 Cases

“…Signs of pansinusitis and dental infection may also be evident during evaluation. 1 , 3 , 4 , 7 , 10 , 11 , 22 , 23 Computed tomography (CT) and magnetic resonance imaging (MRI) are mainstays in diagnosing CNS infections. Radiologic differentiation between SDE and EDA hinges on their relationship to the falx cerebri; SDEs typically remain unilateral, with crescent-like shapes ( Figure 1 ), while EDAs can cross the midline.…”

“… 7 , 14 , 22 , 23 CT is cost-effective for abscess diagnosis, while MRI offers higher sensitivity for small collections and differentiating epidural from subdural. 1 , 4 , 7 , 10 , 11 CT is preferred for neurosurgical planning. 10 , 22 , 24 Our patients underwent CT scans, obviating further imaging needs.…”

“… 3 , 7 Some authors suggested a non-surgical strategy for stable patients with minor midline deviation. 3 , 4 , 8 , 10 , 24 Antibiotic cessation criteria include normalized inflammatory markers and MRI resolution. 6 Surgery relieves compression, evacuates pus and identifies pathogens, often via craniotomy or burr holes.…”

“… 3 Mortality rates have significantly been declined, due to improved medical imaging, antibiotics, and surgical techniques. 4 , 5 These complications often result from contiguous spread or direct invasion from nearby infection sites, notably paranasal sinus and odontogenic sources. They often progress rapidly manifesting with symptoms such as meningismus, neurological deficits, and seizures.…”

A Case of Subdural Empyema Due to Dental Pathogen

“…As seen in our case, if SE is due to tooth infection, experts believe dental extraction may be required in addition to antibiotics [ 10 ]. Moreover, the antibiotics course for SE ranges from three to eight weeks and should include vancomycin or nafcillin, metronidazole, and ceftriaxone or cefepime/ceftazidime for pseudomonas coverage [ 11 , 12 ]. Therapy should be determined by blood work, surgical drainage, bacteriology, radiographic findings, and clinical response.…”