Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

Complicaciones de rinosinusitis aguda en niños del Hospital Sótero del Río / Complications of acute rhinosinusitis in children at Sótero del Río Hospital

Introducción: La rinosonusitis aguda (RSA) es frecuente en niños, respondiendo bien a tratamiento médico en la mayoría de los casos. Sin embargo puede presentar complicaciones graves a nivel orbitario e intracerebral. Objetivo: Evaluaria frecuencia, describirias características clínicas, evaluare! tratamiento y evolución de la rinosinusitis aguda complicada, en niños del Hospital Sótero del Río. Material y método: Estudio retrospectivo-descriptivo realizado en el Hospital Sótero del Río, utilizando fichas clínicas de pacientes ingresados desde enero de 2002 hasta julio de 2007, con diagnóstico de RSA complicada. Resultados: Se incluyeron 27 pacientes con diagnóstico presuntivo de RSA complicada: 30 por ciento con celulitis preseptal aislada, 36 por ciento celulitis postseptal, 26 por ciento absceso subperióstico y 8 por ciento complicaciones intracraneales. La edad promedio fue 4.53 años (4 meses-13 años); 56 por ciento sexo masculino y 44 por ciento sexo femenino; promedio de días hospitalizados 7,24 días (2-19 días); total de días con tratamiento antibiótico 20,2 días (9-38 días); el cultivo microbiológico fue positivo en 25 por ciento de los pacientes con tratamiento quirúrgico (Staphylococcus epidermidis). No existió compromiso visual al alta en ninguno de los pacientes. Conclusión: La complicación más frecuente de RSA fue la orbitaria (92 por ciento) similar a lo descrito en la literatura. El seno etmoidal, maxilar y frontal fueron frecuentemente comprometidos. La edad de presentación de complicación de RSA fue levemente menor a lo descrito en la literatura. Se encontró predominio del género masculino, aunque en los abscesos subperiósticos predominó el sexo femenino. No se encontró relación directa entre la gravedad de RSA y los valores de proteína C reactiva (PCR) y leucocitosis. La mayoría de los abscesos subperiósticos se manejaron médicamente, teniendo la mitad de ellos más de 9 años. Sólo un paciente presentó complicación orbitaria y encefálica...

Introduction: Acute rhinosinusitis (RSA) is frequent in children. Although in most cases responds well to medical treatment, it could result in serious orbital and intracranial complications. Aim: To assess the frequency, describe the clinical characteristics and evaluate treatment and evolution of acute rhinosinusitis in children at Sótero del Rio hospital. Material and Method: Retrospective - descriptive study of clinical data from Sótero del Rio hospital between Jan 2002 and July 2007, involving patients with a diagnosis of complicated RSA. Results: Data from 27 patients were included in this study, all with presumptive RSA complications: 30 percent had isolated preseptal cellulitis, 36 percent had postseptal cellulitis, 26 percent had subperiostal abscesses, and 8 percent had intracranial complications. The average age of patients was 4,53 years (4 months-13 years old); 56 percent were males and 44 percent were females; hospitalization was in average 7,24 days (2 -19 days), the average number of days on antibiotic treatment was 20,2 (9 -38 days); microbiologic culture was positive in 25 percent of patients with surgical treatment (Staphylococcus epidermidis). None of the patients had visual complications when they were discharged from the hospital. Conclusion: The most frequent RSA complication was orbital (92 percent of complications), similar to what is reported in the literature. Ethmoidal, maxilar and frontal sinuses were more often involved. RSA complications presented at a slightly younger age than reported in the literature. More often males were affected, but subperiostal abscesses were more common in females. There was no direct relation between RSA seriousness and C-reactive protein or leukocitosis. Most subperiostal abscesses were medically treated; more than half of these patients were older than 9 years old. Only one patient presented both orbital and intracranial complications