Empiema subdural recidivante secundário à sinusite bacteriana frontal em um adolescente imunocompetente: relato de caso / Relapsing subdural empyema secondary to frontal bacterial sinusitis in an immunocompetent adolescent: case report

A sinusite é uma causa rara de infecção intracraniana, sendo responsável por 2,4% dos casos em pacientes jovens, e tem como a complicação intracraniana mais frequente o empiema subdural (ESD). Descrevemos um caso raro de um adolescente imunocompetente de 16 anos que evoluiu com confusão mental, rebaixamento do nível de consciência, anisocoria, hemiparesia à direita, afasia e febre. Tomografa computadorizada confirmou ESD, e paciente foi submetido à avaliação laboratorial e abordagem clínico-cirúrgica para tratamento do quadro.

Sinusitis is a rare cause of intracranial infection, accounting for 2.4% of cases in young patients. The most frequent intracranial complication is subdural empyema (SDE). We describe a rare case of a 16-year-old immunocompetent adolescent who developed mental confusion, lowered consciousness, anisocoria, right hemiparesis, aphasia, and fever. Computed tomography confirmed SDE, and the patient underwent laboratory evaluation and clinical-surgical approach for treatment of the condition.

Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema / Herniação cerebral intratável secundária a pneumoencéfalo hipertensivo no intraoperatório: uma complicação rara com risco para a vida durante a drenagem de empiema subdural

Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

Resumo O pneumoencéfalo hipertensivo é raro, mas foi bem documentado após trauma e procedimentos neurocirúrgicos. Trata-se de uma emergência cirúrgica porque pode levar à deterioração neurológica, herniação do tronco cerebral e morte. Ao contrário de casos anteriores, nos quais o pneumoencéfalo hipertensivo se desenvolveu no pós-operatório, descrevemos um caso de pneumoencéfalo hipertensivo desenvolvido no período intraoperatório que levou a uma herniação cerebral súbita, maciça e aberta para fora do local da craniotomia. Os possíveis fatores causais são destacados. É imperativo identificar rapidamente as possíveis causas da herniação cerebral aguda no intraoperatório, incluindo o pneumoencéfalo hipertensivo, e instituir medidas apropriadas para minimizar os danos neurológicos.

Empiema raquídeo en pediatría: dificultades en el diagnóstico y las decisiones terapéuticas / Spinal empyema in children: difficulties in the diagnosis and treatment decisions

El empiema raquídeo es una patología poco frecuente en niños. La sospecha clínica del mismo es fundamental para realizar un diagnóstico temprano e iniciar un tratamiento adecuado y oportuno que cambie el pronóstico vital y funcional del paciente. Sin embargo, el mismo es dificultoso en la mayoría de los pacientes dada la poca expresividad clínica al inicio de la enfermedad. En cuanto al tratamiento, se propone que es médico y quirúrgico, estando en discusión la exclusividad del primero y el momento oportuno para el segundo en algunos casos. Se presenta el caso de un niño de 7 años, que presentó un empiema raquídeo en el contexto de una infección de cuero cabelludo. Su presentación clínica, al igual que lo descripto en la literatura, fue insidiosa. Se inició tratamiento antibiótico, pero el aumento de la colección evidenciada en la resonancia magnética requirió la decomprensión quirúrgica. El paciente evolucionó de manera favorable, sin signos neurológicos deficitarios.

Giant hemicranial calcified subdural empyema - unusual complication following ventriculoperitoneal shunt insertion.

The authors describe an extremely unusual case of a giant hemicranial subdural empyema occurring nine years after insertion of a venticuloperitoneal shunt. Though the empyema was evacuated, the child suffered significant morbidity and remained hemiparetic. The present case highlights the delayed morbidity following a ventriculoperitoneal shunt insertion and the need of prolonged and regular follow up in children who have undergone this procedure.

Empiema subdural: complicação de rinossinusite aguda / Subdural empyema: rhinossinusitis complications

Complicações intracranianas das rinossinusites são a extensão do processo infeccioso para estruturas adjacentes, ocorrendo em um pequeno, mas significante número de pacientes. Dentre as de origem nasossinusal o empiema...

Intracranial complications of the sinusitis are the extension of the infectious process for adjacent structures, happening in a small, but significant number of patients. Among the one of nasossinusal origin the subdural empyema...

Spontaneous subdural empyema in malaria: a case study

Malaria is one of the most common diseases in tropical countries. In our country, malaria is endemic in some parts of south and east. Cerebral malaria is usually a diffuse symmetric encephalopathy with focal signs being unusual. We present a two-year old girl with fever and seizure while undergoing treatment for malaria. Imaging disclosed acute subdural empyema. Investigations revealed anemia, thrombocytopenia and positive peripheral blood smear for vivax malaria. Treatment involved surgical evacuation of the subdural empyema, oral chloroquin and antibiotics. This is the third case report of spontaneous subdural empyema in complicated malaria and highlights a rare but surgically manageable complication

Drenaje subduro subgaleal en el tratamiento de colecciones subdurales subagudas o crónicas post-traumáticas / Subduro-subgaleal drainage in the treatment of sub-acute or chronic post-traumatic subdural collection

Se analizó el efecto de la instalación de drenaje subduro/subgaleal (SD/SG) en siete pacientes con colecciones subdurales subagudas o crónicas post-traumáticas. Las principales indicaciones de esta técnica fueron la condición crítica del paciente y el rango etáreo sobre los 65 años con atrofia cerebral. El catéter de drenaje se instaló en pabellón con anestesia local o con anestesia general de acuerdo con las condiciones de cada caso. No se observaron complicaciones, recidiva, infección ni mortalidad en el grupo.

Subdural empyema, diagnostic difficulties and surgical treatment controversy

Subdural empyema [SDE] is a rare form of intracranial sepsis that can rapidly lead to death. This fatal outcome is preventable as the condition can be treated successfully if the diagnosis is made at an early phase of the disease process and appropriate treatment measures are implemented in time. We present 6 cases of SDE out of a total of 71 patients treated for intracranial infections in the Neurosurgery Unit of Hamad General Hospital in Doha. Qatar in the period from January 1996 - December 2000. Fever and headache were the most common symptoms and there were neurological deficits in all patients by the time they were referred to neurosurgical care. Contrast enhanced computerised tomography scan of the brain was diagnostic in all patients although in two of them the initial studies were negative and the subdural collection was only revealed on follow-up imaging. The source of SDE was the paranasal sinuses in 4 patients, gram-negative septicaemia in 1 and was unknown in the sixth patient. Subdural pus collection was more or less confined to one lobe or another of the cerebral hemisphere in 4 patients, all of whom underwent burr hole drainage. In the remaining 2 patients the subdural pus had spread over most of the cerebral hemisphere as well as the interhemispheric space. In each of these cases, a more extensive surgical procedure, in the form of a craniotomy or a craniectomy was required. Subdural pus culture grew streptococcus milleri in 4 patients and was sterile in 1 patient while Burkholderia pseudomalleri was isolated from the blood and subdural pus in the sixth patient. Besides surgical procedures for drainage of SDE, 4 patients also underwent drainage of paranasal sinuses by the ENT surgeons. All patients received intravenous antibiotics for an average of 4 weeks followed by oral antibiotics for about 4 more weeks. A full neurological recovery was achieved in 4 patients with a mean follow-up of 12 months. One patient failed to attend the outpatient clinic for follow-up and there was 1 death that was almost certainly attributed to the delay in diagnosis. The objective of this article is to review the patho-anatomical basis of SDE and address management challenges encountered in treating the condition, namely difficulties hindering early diagnosis and controversies regarding the optimum surgical approach

Empiema espinhal subdural: relato de um acso / Spinal subdural empyema: a case report

A raridade do empiema subdural pode ser verificada pela escassez de casos descritos na literatura. Os autores apresentam mais um caso, mostrando as dificuldades diagnósticas principalmente quando näo há aparente porta de entrada. Enfatizam, nestas circunstâncias, a importância de certos sinais clínicos, o valor da punçäo lombar e da imagem por ressonância nuclear magnética na elucidaçäo diagnóstica. Este último exame näo foi mencionado anteriormente na literatura consultada sobre o assunto. O tratamento cirúrgico, associado à antibioticoterapia, mostrou-se bastante eficaz, principalmente se realizado precocemente

Empiemas intracranianos: esperiência com 12 pacientes / Intracranial empyemas: experience with 12 patients

Os autores analisam o quadro clínico, a origem, os agentes etiológicos e os resultados de 12 pacientes portadores de empiema intracraniano. Propöem o tratamento cirúrgico através de craniotomia ampla, lavagem da cavidade e remoçäo do pus. Faz parte, também, do tratamento, uso de antibióticos, por 6 semanas

Empiema subdural / Subdural empyema

Empiema subdural é uma infecçäo pouco freqüente causada, principalmente, por sinusite; é muitas vezes fatal, quando näo tratado precocemente. Neste artigo, apresentamos um estudo retrospectivo de 40 pacientes tratados cirurgicamente, nos últimos 10 anos

Empiema inter-hemisférico unilateral: consideraçäo técnica / Unilateral interhemispheric subdural empyema

Os autores apresentam as vantagens da craniotomia em decúbito lateral destinada ao tratamento dos empiemas inter-hemisféricos unilaterais