Korean J Pediatr Infect Dis.  2014 Apr;21(1):59-64.

A Case of Subdural Empyema Caused by Sinusitis in a Child

• Byun JH
• Hwang IK
• Park EK
• Kang JW
• Kim DS
• Jang GC

Abstract

The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.

Keyword

Sinusitis; Subdural Empyema; Brain Abscesses; Central Nervous System

MeSH Terms

Adolescent
Anti-Bacterial Agents
Brain Abscess
Cavernous Sinus Thrombosis
Central Nervous System
Child*
Diagnosis
Empyema, Subdural*
Fever
Frontal Sinus
Frontal Sinusitis
Headache
Humans
Inpatients
Male
Maxillary Sinus
Maxillary Sinusitis
Meningitis
Orbit
Paralysis
Sinusitis*
Anti-Bacterial Agents

Figure

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  Fig. 1 Waters' view demonstrating right acute maxillary sinusitis & frontal sinusitis with an air-fluid level.

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  Fig. 2 Axial contrast-enhanced brain CT scan demonstrating small amount of subdural fluid with meningeal enhancement along the anterior falx and right frontal convexity (arrow).

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  Fig. 3 T1 & T2 weighted contrast cerebral MRI showed a thin layer of subdural collection along falx and interhemispheric fissure with restricted diffusion (typical finding of subdural empyema). (A) T2 weighted contrast cerebral MRI showed meningitis extends over right cerebral hemisphere, probably direct extension from sinusitis. (B) T1 weighted contrast cerebral MRI showed multifocal empyemas in right frontal region and along the falx cerebri.

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