CRCM  Vol.2 No.5 , August 2013
Nonsurgical treatment of infratentorial subdural empyema: A case report
ABSTRACT
 Infratentorial subdural empyemas are rare. It is an important neurological infection requiring immediate neurosurgical treatment. The nonsurgical treatment of subdural empyema has been reported sporadically. In this paper the authors report the nonsurgical treatment of a case of infratentorial subdural empyema. The patient with left recurrent otitis was hospitalized with symptoms of headache and fever of 3 weeks duration. Examination revealed that the patient had Glasgow Coma Scale score of 15, fever, mild cerebellar signs, no focal deficit, and abundant suppuration from the left ear. A contrast-enhanced CT scan showed an infratentorial supracerebellar hypodense fluid collection with the peripheral rim enhancement to the left of the midline that mimicked a subdural empyema. Routine hematological investigation revealed polymorphic leukocytosis and elevated erythrocyte sedimentation rate. After the left mastoidectomy and antibiotic treatment, the patient recovered with complete resolution of the subdural empyema on CT scan.

Cite this paper
Sogoba, Y. , Kanikomo, D. , Coulibaly, O. , Singaré, K. , Maiga, Y. , Samaké, D. and Timbo, S. (2013) Nonsurgical treatment of infratentorial subdural empyema: A case report. Case Reports in Clinical Medicine, 2, 294-297. doi: 10.4236/crcm.2013.25079.
References
[1]   Tsai, Y.D., Chang, W.N., Shen, C.C., Lin, Y.C., Lu, C.H., Liliang, P.C., et al. (2003) Intracranial suppuration: A clinical comparison of subdural empyemas and epidural abscesses. Surgical Neurology, 59, 191-196. doi:10.1016/S0090-3019(02)01054-6

[2]   Nathoo, N., Nadvi, S.S. and van Dellen, J.R. (1997) Infratentorial empyema: Analysis of 22 cases. Neurosurgery, 41, 1263-1269. doi:10.1097/00006123-199712000-00005

[3]   Banerjee, A.D., Pandey, P., Devi, B.I., Sampath, S. and Chandramouli, B.A. (2009) Pediatric supratentorial subdural empyemas: A retrospective analysis of 65 cases. Pediatric Neurosurgery, 45, 11-18. doi:10.1159/000202619

[4]   Keet, P.C. (1990) Cranial intradural abscess management of 641 patients during the 35 years from 1952 to 1986. British Journal of Neurosurgery, 4, 273-278. doi:10.3109/02688699008992736

[5]   Nathoo, N., Nadvi, S.S., van Dellen, J.R. and Gouws, E. (1999) Intracranial subdural empyemas in the era of computed tomography: A review of 699 cases. Neurosurgery, 44, 529-536. doi:10.1097/00006123-199903000-00055

[6]   Venkatesh, M.S., Pandey, P., Devi, B.I., Khanapure, K., Satish, S., Sampath, S., et al. (2006) Pediatric infratentorial subdural empyema: Analysis of 14 cases. Journal of Neurosurgery, 105, 370-377.

[7]   Bhandari, Y.S. and Sarkari, N.B.S. (1970) Subdural empyema. A review of 37 cases. Journal of Neurosurgery, 32, 35-39. doi:10.3171/jns.1970.32.1.0035

[8]   Morgan, D.W. and Williams, B. (1985) Posterior fossa subdural empyema. Brain, 108, 983-992. doi:10.1093/brain/108.4.983

[9]   Borovich, B., Johnson, E. and Spagnuolo, E. (1990) Infratentorial subdural empyema: Clinical and computerized tomography findings. Report of three cases. Journal of Neurosurgery, 72, 299-301. doi:10.3171/jns.1990.72.2.0299

[10]   Kojima, A., Yamaguchi, N. and Okui, S. (2004) Supraand infratentorial subdural empyema secondary to septicemia in a patient with liverabscess—Case report. Neurologia Medico-Chirurgica (Tokyo), 44, 90-93. doi:10.2176/nmc.44.90

[11]   Polyzoidis, K.S., Vranos, G., Exarchakos, G., Argyropoulou, M.I., Korantzopoulos, P. and Skevas, A. (2004) Subdural empyema and cerebellar abscess due to chronic otitis media. International Journal of Clinical Practice, 58, 214-217. doi:10.1111/j.1368-5031.2004.0050.x

[12]   Sahjpaul, R.L. and Lee, D.H. (1999) Infratentorial subdural empyema, pituitary abscess, and septic cavernous sinus thrombophlebitis secondary to paranasal sinusitis: Case report. Neurosurgery, 44, 864-866. doi:10.1097/00006123-199904000-00101

[13]   Singh, B. and Maharaj, T.J. (1993) Radical mastoidectomy: Its place in otitic intracranial complications. Journal of Laryngology & Otology, 12, 1113-1118.

[14]   Osman Farah, J., Kandasamy, J., May, P., Buxton, N. and Mallucci, C. (2009) Subdural empyema secondary to sinus infection in children. Child’s Nervous System, 25, 199-205. doi:10.1007/s00381-008-0665-x

[15]   Germiller, J.A., Monin, D.L., Sparano, A.M. and Tom, L.W. (2006) Intracranial complications of sinusitis in children and adolescents and their outcomes. Archives of Otolaryngology—Head and Neck Surgery, 132, 969-976. doi:10.1001/archotol.132.9.969

[16]   Bannister, G., Williams, B. and Smith, S. (1981) Treatment of subdural empyema. Journal of Neurosurgery, 55, 82-88. doi:10.3171/jns.1981.55.1.0082

[17]   Farmer, T.W. and Wise, G.R. (1973) Subdural empyema in infants, children and adults. Neurology, 23, 254-261. doi:10.1212/WNL.23.3.254

[18]   Hitchcock, E. and Andreadis, A. (1964) Subdural empyema: A review of 29 cases. Journal of Neurology, Neurosurgery & Psychiatry, 27, 422-434. doi:10.1136/jnnp.27.5.422

[19]   Williams, B. (1983) Subdural empyema. Advances and Technical Standards in Neurosurgery, 9, 133-170. doi:10.1007/978-3-7091-7034-2_6

[20]   Bok, A.P. and Peter, J.C. (1993) Subdural empyema: Burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases. Journal of Neurosurgery, 78, 574-578. doi:10.3171/jns.1993.78.4.0574

[21]   Mauser, H.W., Ravijst, R.A., Elderson, A., van Gijn, J. and Tulleken, C.A. (1985) Nonsurgical treatment of subdural empyema. Case report. Journal of Neurosurgery, 63, 128-130. doi:10.3171/jns.1985.63.1.0128

[22]   Rosazza, A., de Tribolet, N. and Deonna, T. (1979) Nonsurgical treatment of interhemispheric subdural empyemas. Helvetica Paediatrica Acta, 34, 577-581.

 
 
Top