Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia
Author(s)
Ulf Nestler*,
Daniel Memia-Zolo,
Nidal Salloum,
Mehdi Mejdoubi,
François Lengelle,
Raoul Santiago,
William Cécile,
Remus Stegaru,
Norbert Manzo
Affiliation(s)
Department of Neurosurgery, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Radiology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Anesthesiology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Pediatrics, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Oto-Rhino-Laryngology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies.
Department of Neurosurgery, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Radiology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Anesthesiology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Pediatrics, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies. Department of Oto-Rhino-Laryngology, Centre Hospitalier Universitaire of Fort de France, Fort-de-France, French West Indies.
ABSTRACT
Objective: Sinogenic subdural empyema remains a neurosurgical emergency, even in the antibiotic era. Sickle cell disease is one of the most frequent hereditary diseases, with an incidence of around 4 in 1000 newborns, which necessitates special considerations before a neurosurgical intervention. Case Description: The case of a 10-year-old boy with sickle cell disease type HbSC is reported, who presented with meningitis about ten days after a nasal sinusitis. CT and MRI showed subdural empyema and immediate intravenous antibiotic treatment was started. The patient received partial exchange transfusion. Craniotomy allowed evacuation of empyema and repairment of a frontobasal dural defect. Endoscopic evacuation of the paranasal sinuses was done in the same anesthesia. After initial good recovery, the patient developed right sided paresis with epileptic seizures a few days later. CT scan revealed three distant empyema recurrencies which were evacuated in a second neurosurgical intervention. The child recovered without neurologic deficit, and control MRI examinations three and twelve months after surgery found frontal and parietal dural thickening as sequelae. Conclusion: Urgent neurosurgical interventions in the presence of sickle cell anemia require special anesthesiologic preparations. An immediate, multidisciplinary approach can lead to a good outcome in these life-threatening situations.
Objective: Sinogenic subdural empyema remains a neurosurgical emergency, even in the antibiotic era. Sickle cell disease is one of the most frequent hereditary diseases, with an incidence of around 4 in 1000 newborns, which necessitates special considerations before a neurosurgical intervention. Case Description: The case of a 10-year-old boy with sickle cell disease type HbSC is reported, who presented with meningitis about ten days after a nasal sinusitis. CT and MRI showed subdural empyema and immediate intravenous antibiotic treatment was started. The patient received partial exchange transfusion. Craniotomy allowed evacuation of empyema and repairment of a frontobasal dural defect. Endoscopic evacuation of the paranasal sinuses was done in the same anesthesia. After initial good recovery, the patient developed right sided paresis with epileptic seizures a few days later. CT scan revealed three distant empyema recurrencies which were evacuated in a second neurosurgical intervention. The child recovered without neurologic deficit, and control MRI examinations three and twelve months after surgery found frontal and parietal dural thickening as sequelae. Conclusion: Urgent neurosurgical interventions in the presence of sickle cell anemia require special anesthesiologic preparations. An immediate, multidisciplinary approach can lead to a good outcome in these life-threatening situations.
Cite this paper
U. Nestler, D. Memia-Zolo, N. Salloum, M. Mejdoubi, F. Lengelle, R. Santiago, W. Cécile, R. Stegaru and N. Manzo, "Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia," Open Journal of Modern Neurosurgery, Vol. 3 No. 4, 2013, pp. 53-58. doi: 10.4236/ojmn.2013.34012.
U. Nestler, D. Memia-Zolo, N. Salloum, M. Mejdoubi, F. Lengelle, R. Santiago, W. Cécile, R. Stegaru and N. Manzo, "Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia," Open Journal of Modern Neurosurgery, Vol. 3 No. 4, 2013, pp. 53-58. doi: 10.4236/ojmn.2013.34012.
References
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[1] S. Gupta, S. Vachhrajani, A. Kulkarni, M. D. Taylor, P. Dirks, J. M. Drake and J. T. Rutka, “Neurosurgical Management of Extraaxial Central Nervous System Infections in Children,” Journal of Neurosurgery: Pediatrics, Vol. 7, No. 5, 2011, pp. 441-451. [2] C. W. Hicks, J. G. Weber, J. R. Reid and M. Moodley, “Identifying and Managing Intracranial Complications of Sinusitis in Children,” Pediatric Infectious Disease Journal, Vol. 30, No. 3, 2011, pp. 222-226. http://dx.doi.org/10.1097/INF.0b013e3181f86398 [3] J. H. Piatt, “Intracranial Suppuration Complicating Sinusitis among Children: An Epidemiological and Clinical Study,” Journal of Neurosurgery: Pediatrics, Vol. 7, No. 6, 2011, pp. 567-574. http://dx.doi.org/10.3171/2011.3.PEDS10504 [4] T. P. Tsou, P. I. Lee, C. Y. Lu, L. Y. Chang, L. M. Huang, J. M. Chen, P. R. Hsueh and C. Y. Lee, “Microbiology and Epidemiology of Brain Abscess and Subdural Empyema in a Medical Center: A 10-Year Experience,” Journal of Microbiology, Immunology and Infection, Vol. 42, No. 5, 2009, pp. 405-412. [5] S. C. Leong, L. K. Waugh, A. Sinha and S. De, “Clinical Outcomes of Sinogenic Intracranial Suppuration: The Alder Hey Experience,” Ann Otol Rhinol Laryngol, Vol. 120, No. 5, 2011, pp. 320-325. [6] N. Nathoo, S. S. Nadvi, J. R. van Dellen and E. Gouws, “Intracranial Subdural Empyemas in the Era of Computed Tomography: A Review of 699 Cases,” Neurosurgery, Vol. 44, No. 3, 1999, pp. 529-536. http://dx.doi.org/10.1097/00006123-199903000-00055 [7] F. M. Mbou, L. Martineau, A. Eischen, G. Elana and E. Dupuis, “Clinical Course (Ten Years) of Sickle Cell Disease in Martinique after Neonatal Screening,” Archives de Pédiatrie, Vol. 11, No. 1, 2004, pp. 57-58. http://dx.doi.org/10.1016/j.arcped.2003.09.050 [8] A. K. Ould Amar, O. Delattre, C. Godbille, O. Béra, P. A. Halbout and Y. Catonné, “Assessment of the Use of Transfusion Therapy and Complications in Orthopedic Surgery in Patients with Sickle-Cell Anemia: Retrospective Study,” Transfusion Clinique et Biologique, Vol. 10, No. 2, 2003, pp. 61-66. http://dx.doi.org/10.1016/S1246-7820(03)00021-1 [9] Z. M. Al-Samak, M. M. Al-Falaki and A. A. Pasha, “Assessment of Perioperative Transfusion Therapy and Complications in Sickle Cell Disease Patients Undergoing Surgery,” Middle East Journal of Anesthesiology, Vol. 19, No. 5, 2008, pp. 983-996. [10] T. Moon, R. Y. Lin and A. F. Jahn, “Fatal Frontal Sinusitis Due to Neisseria sicca and Eubacterium lentum,” Journal of Otolaryngology, Vol. 15, No. 3, 1986, pp. 193-195. [11] S. Kuruvath, S. Basu, J. P. Elwitigala, A. Yaneza, S. S. Namnyak and A. R. Aspoas, “Salmonella Enteritidis Brain Abscess in a Sickle Cell Disease Patient: Case Report and Review of the Literature,” International Journal of Infectious Diseases, Vol. 12, No. 3, 2008, pp. 298-302. http://dx.doi.org/10.1016/j.ijid.2007.02.004 [12] V. S. Madhugiri, B. V. Sastri, U. Srikantha, A. D. Banerjee, S. Somanna, B. I. Devi, B. A. Chandramouli and P. Pandey, “Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome,” Pediatric Neurosurgery, Vol. 47, No. 2, 2011, pp. 113-124. http://dx.doi.org/10.1159/000330542 [13] R. Bhatia, K. Harris, J. Hartley, O. Jeelani and W. Harkness, “Serial PCR Genetic Load Determination in the Surgical Management of Pneumococcal Intracranial Sepsis,” Child’s Nervous System, Vol. 28, No. 4, 2012, pp. 515-520. http://dx.doi.org/10.1007/s00381-012-1715-y [14] T. S. Cole, M. E. Clark, A. J. Jenkins and J. E. Clark, “Pediatric Focal Intracranial Suppuration: A UK Single-Center Experience,” Child’s Nervous System, Vol. 28, No. 12, 2012, pp. 2109-2114. http://dx.doi.org/10.1007/s00381-012-1877-7 [15] T. V. Adamkiewicz, S. Sarnaik, G. R. Buchanan, R. V. Iyer, S. T. Miller, C. H. Pegelow, Z. R. Rogers, E. Vichinsky, J. Elliott, R. R. Facklam, K. L. O’Brien, B. Schwartz, C. A. Van Beneden, M. J. Cannon, J. R. Eckman, H. Keyserling, K. Sullivan, W. Y. Wong and W. C. Wang, “Invasive Pneumococcal Infections in Children with Sickle Cell Disease in the Era of Penicillin Prophylaxis, Antibiotic Resistance, and 23-Valent Pneumococcal Polysaccharide Vaccination,” Journal of Pediatrics, Vol. 143, No. 4, 2003, pp. 438-444. http://dx.doi.org/10.1067/S0022-3476(03)00331-7 [16] P. G. Firth, K. N. McMillan, C. M. Haberkern, M. Yaster, M. A. Bender and S. R. Goodwin, “A Survey of Perioperative Management of Sickle Cell Disease in North America,” Pediatric Anesthesia, Vol. 21, No. 1, 2011, pp. 43-49. http://dx.doi.org/10.1111/j.1460-9592.2010.03415.x [17] L. Fisher, “Perioperative Care of the Patient with Sickle Cell Disease,” AORN Journal, Vol. 93, No. 1, 2011, pp. 150-156. http://dx.doi.org/10.1016/j.aorn.2010.08.019 [18] D. C. Rees, T. N. Williams and M. T. Gladwin, “Sickle-Cell Disease,” Lancet, Vol. 376, No. 9757, 2010, pp. 2018-2031. http://dx.doi.org/10.1016/S0140-6736(10)61029-X